Alphabetical Listing by Therapeutic Category GOODFELLOW AFB ROSS CLINIC FORMULARY

GOODFELLOW AFB ROSS CLINIC FORMULARY

Alphabetical Listing by Therapeutic Category

This document is current as of October 8, 2020. The availability of formulary items is subject to change. ACARBOSE Acarbose ALPRAZolam Outpatient Dosage Forms Outpatient Formulary Brands Available Xanax Tablet, Oral: Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg Tablet, Oral: Xanax: 0.5 mg, 1 mg [scored] Acetaminophen Generic: 0.5 mg, 1 mg Outpatient Formulary Brands Available Mapap Children's [OTC]; Mapap [OTC] Aluminum Chloride Hexahydrate Outpatient Dosage Forms Outpatient Formulary Brands Available Drysol Suspension, Oral: Outpatient Dosage Forms Mapap Children's: 160 mg/5 mL (118 mL) [ethanol free; contains propylene Solution, External: glycol, sodium benzoate; cherry flavor] Drysol: 20% (60 mL) Tablet, Oral: Mapap: 325 mg Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone Generic: 325 mg Outpatient Dosage Forms Liquid, Oral: Acetaminophen and Codeine Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and Outpatient Dosage Forms simethicone 20 mg per 5 mL (360 mL) Solution, Oral [C-V]: Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL Amantadine (118 mL) [BCF] Outpatient Dosage Forms Tablet, Oral [C-III]: Capsule, Oral, as hydrochloride: Generic: Acetaminophen 300 mg and codeine phosphate 30 mg [BCF] Generic: 100 mg [BCF] AcetaZOLAMIDE Amiodarone Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 250 mg Generic: 200 mg [BCF] Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone Amitriptyline Outpatient Dosage Forms Outpatient Dosage Forms Solution, Otic: Tablet, Oral, as hydrochloride: Generic: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone Generic: 10 mg [BCF], 25 mg [BCF], 75 mg [BCF] 1% (10 mL) AmLODIPine Acyclovir (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Capsule, Oral: Generic: 200 mg [BCF] Amlodipine and Benazepril Tablet, Oral: Outpatient Formulary Brands Available Lotrel Generic: 800 mg [BCF] Outpatient Dosage Forms Acyclovir (Topical) Capsule, Oral: Lotrel: Outpatient Formulary Brands Available Zovirax 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Outpatient Dosage Forms 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] Cream, External: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Zovirax: 5% (5 g) 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Generic: 5% (5 g) 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Ointment, External: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF] Zovirax: 5% (30 g) Generic: Generic: 5% (30 g) 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg [BCF] Albendazole 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg [BCF] 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg [BCF] Outpatient Formulary Brands Available Albenza 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg [BCF] Outpatient Dosage Forms 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg [BCF] Tablet, Oral: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg [BCF Albenza: 200 mg [contains saccharin sodium] Generic: 200 mg Amoxicillin Albuterol Outpatient Dosage Forms Capsule, Oral: Outpatient Formulary Brands Available Proventil® HFA Generic: 250 mg [BCF], 500 mg [BCF] Outpatient Dosage Forms Suspension Reconstituted, Oral: Aerosol Solution, Inhalation: Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (150 mL) [BCF]; 400 mg/5 mL ProAir HFA: 90 mcg/actuation (8.5 g) (100 mL) [BCF] Generic: 90 mcg/actuation (8.5 g) Tablet, Oral: Nebulization Solution, Inhalation: Generic: 875 mg Generic: 0.083% [2.5 mg/3 mL] (60s) [BCF] Nebulization Solution, Inhalation [preservative free]: Amoxicillin and Clavulanate Generic: 0.083% [2.5 mg/3 mL] (60s) [BCF] Outpatient Dosage Forms Suspension Reconstituted, Oral: Alendronate Generic: Outpatient Formulary Brands Available Fosamax 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (100 Outpatient Dosage Forms mL) [BCF] Tablet, Oral: 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (100 Fosamax: 35 mg [BCF], 70 mg [BCF] mL) [BCF] Generic: 35 mg [BCF], 70 mg [BCF] 600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (125 mL) [BCF] Alfuzosin Tablet, Oral: Outpatient Formulary Brands Available Uroxatral Generic: Outpatient Dosage Forms 500: Amoxicillin 500 mg and clavulanate potassium 125 mg [BCF] Tablet Extended Release 24 Hour, Oral, as hydrochloride: 875: Amoxicillin 875 mg and clavulanate potassium 125 mg [BCF] Uroxatral: 10 mg [BCF] Tablet Extended Release 12 Hour, Oral: Generic: 10 mg [BCF] Generic: Amoxicillin 1000 mg and clavulanate acid 62.5 mg Allopurinol Anastrozole Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 100 mg [BCF], 300 mg [BCF] Generic: 1 mg 2 CALCITRIOL (SYSTEMIC) Apixaban Outpatient Dosage Forms Outpatient Formulary Brands Available Eliquis Lozenge, Mouth/Throat: Outpatient Dosage Forms Cepacol Sore Throat: 15 mg (16 ea) [contains cetylpyridinium, menthol; cherry Tablet, Oral: flavor] Eliquis: 5 mg Benzonatate ARIPiprazole Outpatient Formulary Brands Available Tessalon Perles Outpatient Formulary Brands Available Abilify Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Tablet, Oral: Tessalon Perles: 100 mg Abilify: 2 mg, 5 mg, 10 mg Generic: 100 mg Generic: 2 mg, 5 mg, 10 mg Benzoyl Peroxide Artificial Tears Outpatient Dosage Forms Outpatient Dosage Forms Gel, External: Ointment, Ophthalmic: Generic: 2.5% (60 g), 10% (45 g) Refresh P.M.: 3.5 g Solution, Ophthalmic: Liquid, External [wash]: Generic: Polyvinyl alcohol 1.4% (15 mL, 30 mL) Generic: 5% (148 g); 10% (148 g) Aspirin Benztropine Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Chewable, Oral: Tablet, Oral, as mesylate: Generic: 81 mg Generic: 1 mg [BCF] Tablet, Enteric Coated, Oral: Generic: 81 mg, 325 mg Betamethasone and Clotrimazole Outpatient Dosage Forms Atenolol Cream, External: Outpatient Dosage Forms Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole Tablet, Oral: 1% (15 g) Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Bisacodyl AtoMOXetine Outpatient Formulary Brands Available Ducodyl [OTC] Outpatient Formulary Brands Available Strattera Outpatient Dosage Forms Outpatient Dosage Forms Suppository, Rectal: Capsule, Oral: Generic: 10 mg (12 ea, 50 ea, 100 ea) Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg Generic: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg Tablet Delayed Release, Oral: Ducodyl: 5 mg AtorvaSTATin Outpatient Formulary Brands Available Lipitor Bismuth Subsalicylate Outpatient Dosage Forms Outpatient Formulary Brands Available Peptic Relief [OTC] Tablet, Oral: Outpatient Dosage Forms Lipitor: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Tablet Chewable, Oral, as subsalicylate: Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Peptic Relief: 262 mg Generic: 262 mg Atovaquone and Proguanil Outpatient Formulary Brands Available Malarone Brimonidine (Ophthalmic) Outpatient Dosage Forms Outpatient Formulary Brands Available Alphagan P Tablet, Oral: Outpatient Dosage Forms Malarone: Atovaquone 250 mg and proguanil hydrochloride 100 mg Solution, Ophthalmic, as tartrate: Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg Alphagan P: 0.1% (10 mL); 0.15% (5 mL) [contains Purite] Atropine (Ophthalmic) Generic: 0.15% (5 mL) [BCF]; 0.2% (5 mL) [BCF] Outpatient Dosage Forms Budesonide (Oral Inhalation) Solution, Ophthalmic, as sulfate [drops]: Outpatient Dosage Forms Generic: 1% (15 mL) Suspension, Inhalation: Azelastine (Nasal) Generic: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL) Outpatient Dosage Forms BuPROPion Solution, Nasal, as hydrochloride: Generic: 0.1% [137 mcg/spray] (30 mL) Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Azithromycin (Systemic) Generic: 75 mg [BCF] Outpatient Formulary Brands Available Zithromax Tablet Extended Release 12 Hour, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 100 mg [BCF] Packet, Oral: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Zithromax: 1 g (3 ea) [cherry-banana flavor] [BCF] Generic: 300 mg [BCF] Generic: 1 g (3 ea) [BCF] Suspension Reconstituted, Oral: BusPIRone Zithromax: 100 mg/5 mL (15 mL) [cherry-vanilla-banana flavor] [BCF] Outpatient Dosage Forms Zithromax: 200 mg/5 mL (15 mL) [cherry flavor] Tablet, Oral, as hydrochloride: Generic: 100 mg/5 mL (15 mL) [BCF]; 200 mg/5 mL (15 mL) Generic: 5 mg [BCF], 15 mg [BCF] Tablet, Oral: Generic: 500 mg [BCF] Butalbital, Acetaminophen, and Caffeine Bacitracin and Polymyxin B (Ophthalmic) Outpatient Dosage Forms Tablet, Oral: Outpatient Dosage Forms Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg [BCF] Ointment, Ophthalmic: Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g) Calcipotriene Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) Outpatient Dosage Forms Outpatient Dosage Forms Ointment, External: Ointment, Ophthalmic: Generic: 0.005% (60 g) Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units Calcitriol (Systemic) per g (3.5 g) [BCF] Outpatient Dosage Forms Benzocaine Capsule, Oral: Outpatient Formulary Brands Available Cepacol Sore Throat [OTC] Generic: 0.25 mcg 3 CALCIUM AND VITAMIN D Calcium and Vitamin D Ciclopirox Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Solution, External: Generic: Calcium 500 mg and vitamin D 200 units; Calcium 600 mg and Generic: 8% (6.6 mL) vitamin D 200 int. units Tablet, Chewable, Oral: Ciprofloxacin and Dexamethasone Generic : Calcium 500 mg and vitamin D 400 int. units; calcium 600 mg and Outpatient Formulary Brands Available Ciprodex vitamin D 400 int. units Outpatient Dosage Forms Suspension, Otic: Capsaicin Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains Outpatient Dosage Forms benzalkonium chloride] Cream, External: Generic: 0.025% (60 g) Ciprofloxacin (Systemic) Outpatient Dosage Forms Captopril Tablet, Oral, as hydrochloride [strength expressed as base]: Outpatient Dosage Forms Generic: 500 mg [BCF] Tablet, Oral: Generic: 50 mg [BCF] Citalopram Outpatient Dosage Forms Carbidopa and Levodopa Tablet, Oral: Outpatient Dosage Forms Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Tablet, Oral: Generic: Clarithromycin 25/100: Carbidopa 25 mg and levodopa 100 mg [BCF] Outpatient Dosage Forms 25/250: Carbidopa 25 mg and levodopa 250 mg [BCF] Tablet, Oral: Tablet Extended Release, Oral: Generic: 500 mg Generic: 25/100: Carbidopa 25 mg and levodopa 100 mg Clindamycin and Benzoyl Peroxide Carboxymethylcellulose Outpatient Dosage Forms Outpatient Formulary Brands Available Refresh Celluvisc [OTC]; Refresh Gel, External: Plus [OTC] Generic: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (50 g) Outpatient Dosage Forms Clindamycin (Systemic) Solution, Ophthalmic, as sodium [preservative free]: Outpatient Dosage Forms Refresh Celluvisc: 1% (0.4 mL) [30/box] Capsule, Oral, as hydrochloride [strength expressed as base]: Refresh Plus: 0.5% (0.4 mL) [30/box] Generic: 150 mg [BCF], 300 mg Carvedilol Clindamycin (Topical) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Solution, External, as phosphate [strength expressed as base]: Generic: 3.125 mg [BCF], 6.25 mg [BCF], 12.5 mg [BCF], 25 mg [BCF] Generic: 1% (60 mL) [BCF] Cefdinir Clobetasol Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Cream, External, as propionate: Generic: 300 mg Generic: 0.05% (15 g, 30 g) Suspension Reconstituted, Oral: Foam, External: Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (100 mL) Generic: 0.05% (100 g) Ointment, External, as propionate: Cefprozil Generic: 0.05% (15 g, 30 g) Outpatient Dosage Forms Shampoo, External, as propionate: Suspension Reconstituted, Oral: Generic: 0.05% (118 mL) Generic: 125 mg/5 mL (100 mL) ClomiPHENE Cefuroxime Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as citrate: Tablet, Oral, as axetil [strength expressed as base]: Generic: 50 mg Generic: 250 mg, 500 mg ClonazePAM Celecoxib Outpatient Dosage Forms Outpatient Formulary Brands Available CeleBREX Tablet, Oral: Outpatient Dosage Forms Generic: 0.5 mg [BCF], 1 mg Capsule, Oral: CeleBREX: 100 mg, 200 mg CloNIDine Generic: 100 mg, 200 mg Outpatient Formulary Brands Available Catapres-TTS-1 Outpatient Dosage Forms Cephalexin Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 0.1 mg [BCF], 0.2 mg [BCF] Capsule, Oral: Generic: 250 mg [BCF], 500 mg [BCF] Clopidogrel Suspension Reconstituted, Oral: Outpatient Formulary Brands Available Plavix Generic: 250 mg/5 mL (200 mL) [BCF] Outpatient Dosage Forms Tablet, Oral: Cetirizine (Systemic) Plavix: 75 mg [BCF] Outpatient Dosage Forms Generic: 75 mg [BCF] Syrup, Oral, as hydrochloride: Generic: 5 mg/5 mL (120 mL) Clotrimazole (Oral) Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 10 mg Troche, Mouth/Throat: Generic: 10 mg Chlorhexidine Gluconate (Oral) Outpatient Dosage Forms Clotrimazole (Topical) Solution, Mouth/Throat: Outpatient Dosage Forms Generic: 0.12% (473 mL) [BCF] Cream, External: Generic: 1% (15 g, 30 g, 45 g) Chlorthalidone Cream, Vaginal: Outpatient Dosage Forms Generic: 1% (45 g) Tablet, Oral: Solution, External: Generic: 25 mg [BCF], 50 mg [BCF] Generic: 1% (10 mL, 30 mL) 4 DOCUSATE Colchicine Tablet, Oral: Outpatient Dosage Forms Generic: Tablet, Oral: 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Colcrys: 0.6 mg 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sulfate 1.25 mg (equivalent to amphetamine base 3.13 mg)] Generic: 0.6 mg 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate Colestipol 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sul- Outpatient Formulary Brands Available Colestid fate 2.5 mg (equivalent to amphetamine base 6.3 mg)] Outpatient Dosage Forms Diabetic Supplies Packet, Oral, as hydrochloride: Outpatient Formulary Brands Available BD Syringe; FreeStyle Lite Colestid: 5 g (30 ea) [unflavored flavor] Outpatient Dosage Forms Generic: 5 g (30 ea) Lancet: 100/box Tablet, Oral, as hydrochloride: Syringe and needle: Colestid: 1 g BD Insulin Syringe (Ultra-Fine) 30 gauge x 1/2" (0.3 mL) Generic: 1 g BD Syringe 0.5 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF] Cyanocobalamin BD Syringe 1 mL (Ultra-Fine II) 31 gauge x 5/16" [BCF] BD Syringe 0.5 mL (Ultra-Fine) 30 gauge [100/box] Outpatient Dosage Forms BD Ultra-Fine Short Pen Needle 31 gauge X 5 mm [100/box] Solution, Injection: BD Ultra-Fine Short Pen Needle 31 gauge X 8 mm [100/box] Generic: 1000 mcg/mL (1 mL) Test Strips: Tablet,Oral: FreeStyle Lite [50/box] Generic: 1000 mcg DiazePAM Cyclobenzaprine Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 5 mg [BCF] Generic: 5 mg, 10 mg [BCF] Diclofenac (Ophthalmic) CycloSPORINE (Ophthalmic) Outpatient Dosage Forms Outpatient Formulary Brands Available Restasis Solution, Ophthalmic, as sodium: Outpatient Dosage Forms Generic: 0.1% (2.5 mL) Emulsion, Ophthalmic [preservative free]: Restasis: 0.05% (0.4 mL) [contains castor oil] Diclofenac (Systemic) Outpatient Dosage Forms Cyproheptadine Tablet Delayed Release, Oral, as sodium: Outpatient Dosage Forms Generic: 50 mg, 75 mg Tablet, Oral, as hydrochloride: Diclofenac (Topical) Generic: 4 mg [BCF] Outpatient Formulary Brands Available Voltaren Desipramine Outpatient Dosage Forms Outpatient Dosage Forms Gel, Transdermal, as sodium: Tablet, Oral, as hydrochloride: Voltaren: 1% (100 g) [contains isopropyl alcohol, propylene glycol] Generic: 25 mg, 50 mg Dicloxacillin Desmopressin Outpatient Dosage Forms Outpatient Formulary Brands Available DDAVP Capsule, Oral: Outpatient Dosage Forms Generic: 250 mg [BCF] Tablet, Oral, as acetate: Dicyclomine DDAVP: 0.1 mg, 0.2 mg [scored] Outpatient Dosage Forms Generic: 0.1 mg, 0.2 mg Capsule, Oral, as hydrochloride: Desonide Generic: 10 mg [BCF] Tablet, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 20 mg [BCF] Cream, External: Generic: 0.05% (60 g) Difluprednate Outpatient Formulary Brands Available Durezol DexAMETHasone (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Emulsion, Ophthalmic: Tablet, Oral: Durezol: 0.05% (5 mL) [contains sorbic acid] Generic: 4 mg Digoxin Dexmethylphenidate Outpatient Formulary Brands Available Lanoxin Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 5 mg Lanoxin: 125 mcg [BCF], 250 mcg [BCF] [scored] Dextroamphetamine and Amphetamine DilTIAZem Outpatient Formulary Brands Available Adderall XR Outpatient Formulary Brands Available Tiazac Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Extended Release, Oral: Capsule Extended Release 24 Hour, Oral, as hydrochloride: Adderall XR Tiazac: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate 360 mg [BCF] 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul- Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF], 300 mg [BCF], fate 1.25 mg (equivalent to amphetamine base 3.1 mg)] [BCF] 360 mg [BCF] 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sul- DiphenhydrAMINE (Systemic) fate 2.5 mg (equivalent to amphetamine base 6.3 mg)] [BCF] Outpatient Dosage Forms 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccha- Capsule, Oral, as hydrochloride: rate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphet- Generic: 25 mg amine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] [BCF] Dipyridamole 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate Outpatient Dosage Forms 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate Tablet, Oral: 5 mg (equivalent to amphetamine base 12.5 mg)] [BCF] Generic: 25 mg 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sul- Docusate fate 7.5 mg (equivalent to amphetamine base 18.8 mg)] [BCF] Outpatient Formulary Brands Available Colace [OTC] 5 DOCUSATE Outpatient Dosage Forms Esomeprazole Capsule, Oral, as sodium: Outpatient Dosage Forms Colace: 100 mg [contains fd&c red #40, fd&c yellow #6 (sunset yellow)] Capsule Delayed Release, Oral, as magnesium [strength expressed as base]: Donepezil Generic: 20 mg, 40 mg Outpatient Formulary Brands Available Aricept Estradiol (Systemic) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Patch Weekly, Transdermal: Aricept: 5 mg, 10 mg Generic: 0.025 mg/24 hours (4 ea) [BCF]; 0.0375 mg/24 hours (4 ea) [BCF]; Generic: 5 mg, 10 mg 0.05 mg/24 hours (4 ea) [BCF]; 0.1 mg/24 hours (4 ea) [BCF] Tablet, Oral: Dorzolamide and Timolol Generic: 1 mg, 2 mg Outpatient Dosage Forms Solution, Ophthalmic: Estradiol (Topical) Generic: Dorzolamide hydrochloride 2% [strength expressed as base] and Outpatient Formulary Brands Available Estrace timolol maleate 0.5% [strength expressed as base] (10 mL) Outpatient Dosage Forms Doxazosin Cream, Vaginal: Estrace: 0.1 mg/g (42.5 g) Outpatient Dosage Forms Generic: 0.1 mg/g (42.5 g) Tablet, Oral: Generic: 1 mg, 2 mg, 4 mg, 8 mg Estrogens (Conjugated/Equine) and Medroxyprogesterone Doxepin (Systemic) Outpatient Formulary Brands Available Prempro Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Capsule, Oral: Prempro: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone Generic: 10 mg [BCF], 25 mg [BCF] acetate 1.5 mg [BCF] Doxycycline Prempro: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone Outpatient Dosage Forms acetate 1.5 mg [BCF] Tablet, Oral, as hyclate [strength expressed as base]: Prempro: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogester- Generic: 100 mg [BCF] one acetate 2.5 mg [BCF] Prempro: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone Eletriptan acetate 5 mg [BCF] Outpatient Formulary Brands Available Relpax Estrogens (Conjugated/Equine, Systemic) Outpatient Dosage Forms Tablet, Oral: Outpatient Formulary Brands Available Premarin Relpax: 20 mg, 40 mg Outpatient Dosage Forms Generic: 20 mg, 40 mg Tablet, Oral: Premarin: 0.3 mg [BCF], 0.45 mg [BCF], 0.625 mg [BCF], 0.9 mg, Emollients 1.25 mg [BCF] Outpatient Formulary Brands Available Dermabase [OTC]; Hydrocerin [OTC] Estrogens (Conjugated/Equine, Topical) Outpatient Dosage Forms Outpatient Formulary Brands Available Premarin Cream, External: Outpatient Dosage Forms Dermabase: 454 g Cream, Vaginal: Hydrocerin: 454 g Premarin: 0.625 mg/g (30 g) [BCF] Enoxaparin Eszopiclone Outpatient Formulary Brands Available Lovenox Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Solution, Subcutaneous, as sodium [preservative free]: Generic: 2 mg, 3 mg Lovenox: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF]; Ethinyl Estradiol and Desogestrel 60 mg/0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL Outpatient Formulary Brands Available Ortho-Cept (1 mL) [BCF] [prefilled syringe] Generic: 30 mg/0.3 mL (0.3 mL) [BCF]; 40 mg/0.4 mL (0.4 mL) [BCF]; 60 mg/ Outpatient Dosage Forms 0.6 mL (0.6 mL) [BCF]; 80 mg/0.8 mL (0.8 mL) [BCF]; 100 mg/mL (1 mL) Tablet, Oral: [BCF]; 150 mg/mL (1 mL) [BCF] Ortho-Cept 28: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg (28s) [21 light orange tablets and 7 green inactive tablets] EPINEPHrine (Systemic) Outpatient Formulary Brands Available EpiPen 2-Pak; EpiPen Jr 2-Pak Ethinyl Estradiol and Drospirenone Outpatient Dosage Forms Outpatient Formulary Brands Available Yasmin; Yaz Solution Auto-injector, Injection: Outpatient Dosage Forms EpiPen 2-Pak: 0.3 mg/0.3 mL (2 mL) [contains sodium metabisulfite; 1:1000 Tablet, Oral: solution; delivers 0.3 mg per injection] Yasmin: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 yellow active EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 mL) [contains sodium metabisulfite; tablets and 7 white inactive tablets] (28s) [BCF] 1:2000 solution; delivers 0.15 mg per injection] Yaz: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [24 light pink tablets Generic: 0.15 mg/0.3 mL (1 ea); 0.15 mg/0.15 mL (1 ea [DSC], 2 ea); 0.3 mg/ and 4 white inactive tablets] (28s) [BCF] 0.3 mL (1 ea) Ethinyl Estradiol and Ethynodiol Diacetate Erythromycin (Ophthalmic) Outpatient Formulary Brands Available Zovia 1/35 Outpatient Dosage Forms Outpatient Dosage Forms Ointment, Ophthalmic: Tablet, Oral: Generic: 5 mg/g (3.5 g) [BCF] Zovia 1/35: Ethinyl estradiol 0.035 mg and ethynodiol diacetate 1 mg [21 light pink tablets and 7 white inactive tablets] Erythromycin (Systemic) Outpatient Formulary Brands Available E.E.S. Ethinyl Estradiol and Etonogestrel Outpatient Dosage Forms Outpatient Formulary Brands Available NuvaRing Tablet, Oral, as ethylsuccinate: Outpatient Dosage Forms E.E.S. 400: 400 mg [contains fd&c red #40, fd&c yellow #10 (quinoline yellow)] Ring, Vaginal: Generic: 400 mg NuvaRing: Ethinyl estradiol 0.015 mg and etonogestrel 0.12 mg per 24 hours (1 ea) [latex free] Erythromycin (Topical) Outpatient Dosage Forms Ethinyl Estradiol and Levonorgestrel Solution, External: Outpatient Formulary Brands Available Lessina; Levora; Trivora Generic: 2% (60 mL) [BCF] Outpatient Dosage Forms Tablet, Oral: Escitalopram Lessina: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 pink tablets Outpatient Dosage Forms and 7 white inactive tablets] (28s) [BCF] Tablet, Oral: Levora: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 white tablets Generic: 5 mg, 10 mg, 20 mg and 7 peach inactive tablets] (28s) [BCF] 6 FLUTICASONE AND SALMETEROL Trivora: Fenofibrate and Derivatives Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 blue Outpatient Formulary Brands Available TriCor tablets] Outpatient Dosage Forms Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 white Tablet, Oral, as fenofibrate: tablets] TriCor: 48 mg [BCF], 145 mg [BCF] [contains soybean lecithin] Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 pink Generic: 54 mg, 160 mg tablets] Day 22-28: 7 peach inactive tablets (28s) Ferrous Sulfate Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 tablets] and Outpatient Dosage Forms ethinyl estradiol 0.01 mg [7 tablets] (91s) Liquid, Oral: Generic: 75 mg/mL (50 mL) [elemental iron 15 mg/mL] Ethinyl Estradiol and Norelgestromin Tablet, Oral: Outpatient Formulary Brands Available Ortho Evra Generic: 325 mg [elemental iron 65 mg] Outpatient Dosage Forms Patch Weekly, Transdermal: Fexofenadine Ortho Evra: Ethinyl estradiol 0.75 mg and norelgestromin 6 mg (3s) [releases Outpatient Dosage Forms ethinyl estradiol 20 mcg and norelgestromin 150 mcg per day] Tablet, Oral, as hydrochloride: Generic: 30 mg, 60 mg, 180 mg Ethinyl Estradiol and Norethindrone Outpatient Formulary Brands Available Lo Loestrin Fe; Loestrin Fe 1.5/30; Fexofenadine and Pseudoephedrine Loestrin Fe 1/20; Norinyl 1+35 Outpatient Formulary Brands Available Allegra-D 12 Hour [OTC] Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Extended Release, Oral: Tablet, Oral: Allegra-D 12 Hour: Fexofenadine hydrochloride 60 mg [immediate release] Loestrin Fe 1/20: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg and pseudoephedrine hydrochloride 120 mg [extended release] [21 tablets] and ferrous fumarate 75 mg [7 tablets] [DSC] Generic: Fexofenadine hydrochloride 60 mg [immediate release] and pseu- Loestrin Fe 1.5/30: Ethinyl estradiol 0.03 mg and norethindrone acetate doephedrine hydrochloride 120 mg [extended release] 1.5 mg [21 tablets] and ferrous fumarate 75 mg [7 tablets] [contains fd&c red #40 aluminum lake] Finasteride Norinyl 1+35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) [21 Outpatient Dosage Forms yellow-green tablets and 7 orange inactive tablets] [BCF] Tablet, Oral: Generic: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [21 tablets] Generic: 5 mg [BCF] and ferrous fumarate 75 mg [7 tablets] Flecainide Ethinyl Estradiol and Norgestimate Outpatient Dosage Forms Outpatient Formulary Brands Available MonoNessa; Ortho Tri-Cyclen Lo; Tablet, Oral, as acetate: Ortho-Cyclen; Sprintec; TriNessa Generic: 50 mg, 100 mg, 150 mg Outpatient Dosage Forms Tablet, Oral: Fluconazole MonoNessa: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue Outpatient Dosage Forms tablets and 7 green inactive tablets] [BCF] Tablet, Oral: Ortho-Cyclen: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg (28s) [21 Generic: 150 mg [BCF] blue tablets and 7 green inactive tablets] Fluocinolone (Topical) Ortho Tri-Cyclen Lo [BCF]: Outpatient Dosage Forms Day 1-7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 white Solution, External, as acetonide: tablets] Generic: 0.01% (60 mL) Day 8-14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light blue tablets] Fluocinonide Day 15-21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark Outpatient Dosage Forms blue tablets] Cream, External: Day 22-28: 7 dark green inactive tablets Generic: 0.05% (15 g, 30 g, 60 g) [BCF] Sprintec: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue Gel, External: tablets and 7 white inactive tablets] [BCF] Generic: 0.05% (15 g) TriNessa [BCF]: Ointment, External: Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white Generic: 0.05% (15 g, 60 g) tablets] Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue Fluoride tablets] Outpatient Formulary Brands Available Gel-Kam [OTC]; PreviDent 5000 Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Plus tablets] Outpatient Dosage Forms Day 22-28: 7 green inactive tablets Cream, Oral, as sodium [toothpaste]: PreviDent 5000 Plus: 1.1% (51 g) [contains sodium benzoate; spearmint Ethinyl Estradiol and Norgestrel flavor; equivalent to fluoride 2.5 mg/dose] Outpatient Formulary Brands Available Lo/Ovral-28; Low-Ogestrel Gel, Topical, as stannous flouride: Outpatient Dosage Forms Gel-Kam: 0.4% (129 g) [mint flavor] Tablet, Oral: Solution, Oral, as sodium [drops]: Lo/Ovral-28: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white tablets Generic: 1.1 mg/mL (50 mL) [equivalent to fluoride 0.5 mg/mL] and 7 pink inactive tablets] (28s) Fluorometholone Low-Ogestrel: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 white Outpatient Dosage Forms tablets and 7 peach inactive tablets] Suspension, Ophthalmic, as base: Exenatide Generic: 0.1% (5 mL) Outpatient Formulary Brands Available Bydureon BCise FLUoxetine Outpatient Dosage Forms Outpatient Dosage Forms Auto-injector, Subcutaneous: Capsule, Oral: Bydureon BCise: 2 mg/0.85 mL (0.85 mL) Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF] Solution, Oral: Ezetimibe Generic: 20 mg/5 mL (5 mL, 120 mL) [BCF] Outpatient Formulary Brands Available Zetia Outpatient Dosage Forms Fluticasone and Salmeterol Tablet, Oral: Outpatient Formulary Brands Available Advair Diskus; Advair HFA Zetia: 10 mg Outpatient Dosage Forms Generic: 10 mg Aerosol, for Oral Inhalation: Advair HFA: Felodipine 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per inhalation Outpatient Dosage Forms (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Tablet Extended Release 24 Hour, Oral: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg per inhala- Generic: 2.5 mg, 5 mg, 10 mg tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] 7 FLUTICASONE AND SALMETEROL 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg per inhala- Glycerin tion (12 g) [chlorofluorocarbon free; 120 metered actuations] [BCF] Outpatient Dosage Forms Powder, for Oral Inhalation: Suppository, Rectal [pediatric]: Advair Diskus: Generic: 82.5% (12s) 100/50: Fluticasone propionate 100 mcg and salmeterol 50 mcg (14s, 60s) [contains lactose] [BCF] Griseofulvin 250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (14s, 60s) Outpatient Formulary Brands Available Gris-PEG [contains lactose] [BCF] Outpatient Dosage Forms 500/50: Fluticasone propionate 500 mcg and salmeterol 50 mcg (14s, 60s) Suspension, Oral: [contains lactose] [BCF] Generic: 125 mg/5 mL (120 mL) [BCF] Tablet, Oral: Fluticasone (Nasal) Gris-PEG: 125 mg [BCF], 250 mg [BCF] [scored] Outpatient Dosage Forms Generic: 250 mg [BCF] Suspension, Nasal, as propionate: Flonase: 50 mcg/inhalation (16 g) [contains benzalkonium chloride; 120 GuaiFENesin metered actuations] [BCF] Outpatient Formulary Brands Available Mucinex [OTC] Generic: 50 mcg/inhalation (16 g) [BCF] Outpatient Dosage Forms Syrup, Oral: Fluticasone (Oral Inhalation) Generic: 100 mg/5 mL (118 mL) Outpatient Formulary Brands Available Flovent Diskus; Flovent HFA Tablet Extended Release 12 Hour, Oral: Outpatient Dosage Forms Mucinex: 600 mg Aerosol, Inhalation, as propionate: Flovent HFA: 44 mcg/actuation (10.6 g) [BCF] Guaifenesin and Codeine Flovent HFA: 110 mcg/actuation (12 g) [BCF] Outpatient Dosage Forms Flovent HFA: 220 mcg/actuation (12 g) [BCF] Solution, Oral: Aerosol Powder Breath Activated, Inhalation, as propionate: Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL Flovent Diskus: 50 mcg/blister (60s) [contains lactose] [BCF] (118 mL) Flovent Diskus: 100 mcg/blister (60s) [contains lactose] [BCF] Flovent Diskus: 250 mcg/blister (60s) [contains lactose] [BCF] Guaifenesin and Dextromethorphan Outpatient Formulary Brands Available Mucinex DM [OTC] Folic Acid Outpatient Dosage Forms Outpatient Dosage Forms Syrup, Oral: Tablet, Oral: Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per Generic: 1 mg [BCF] 5 mL (118 mL) Tablet, Extended Release, Oral: Furosemide Mucinex DM: Guaifenesin 600 mg and dextromethorphan hydrobro- Outpatient Dosage Forms mide 30 mg Solution, Oral: Generic: 10 mg/mL (60 mL, 120 mL) [BCF] Guaifenesin and Pseudoephedrine Tablet, Oral: Outpatient Formulary Brands Available Mucinex D [OTC] Generic: 20 mg [BCF], 40 mg [BCF], 80 mg Outpatient Dosage Forms Tablet Extended Release 12 Hour, Oral: Gabapentin Mucinex D: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg Outpatient Dosage Forms Generic: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg Capsule, Oral: Generic: 100 mg [BCF], 300 mg [BCF], 400 mg [BCF] GuanFACINE Tablet, Oral: Outpatient Dosage Forms Generic: 600 mg [BCF], 800 mg [BCF] Tablet Extended Release 24 Hour, Oral: Gemfibrozil Generic: 1 mg, 2 mg, 3 mg Outpatient Dosage Forms HydrALAZINE Tablet, Oral: Outpatient Dosage Forms Generic: 600 mg [BCF] Tablet, Oral, as hydrochloride: Gentamicin (Ophthalmic) Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Outpatient Formulary Brands Available Garamycin; Gentak HydroCHLOROthiazide Outpatient Dosage Forms Outpatient Dosage Forms Ointment, Ophthalmic: Capsule, Oral: Gentak: 0.3% (3.5 g) [BCF] Generic: 12.5 mg [BCF] Ointment, Ophthalmic [preservative free]: Tablet, Oral: Garamycin: 0.3% (3.5 g) [BCF] Generic: 25 mg [BCF], 50 mg [BCF] Solution, Ophthalmic [drops]: Generic: 0.3% (5 mL) [BCF] Hydrochlorothiazide and Triamterene Outpatient Dosage Forms Glimepiride Tablet, Oral: Outpatient Dosage Forms Generic: Tablet, Oral: Hydrochlorothiazide 25 mg and triamterene 37.5 mg [BCF] Generic: 2 mg Hydrochlorothiazide 50 mg and triamterene 75 mg [BCF] GlipiZIDE Hydrocodone and Acetaminophen Outpatient Formulary Brands Available Glucotrol XL Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: Generic: 5 mg [BCF], 10 mg [BCF] Hydrocodone bitartrate 5 mg and acetaminophen 325 mg Tablet Extended Release 24 Hour, Oral: Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg Glucotrol XL: 2.5 mg, 5 mg, 10 mg Hydrocodone bitartrate 10 mg and acetaminophen 325 mg Generic: 2.5 mg, 5 mg, 10 mg Hydrocodone and Chlorpheniramine Glucagon Outpatient Dosage Forms Outpatient Formulary Brands Available Glucagon Emergency Suspension, Extended Release, Oral: Outpatient Dosage Forms Generic: Hydrocodone polistirex [equivalent to hydrocodone bitartrate 10 mg] Kit, Injection: and chlorpheniramine polistirex [equivalent to chlorpheniramine maleate Glucagon Emergency: 1 mg [contains lactose] 8 mg] per 5 mL (480 mL) GlyBURIDE Hydrocortisone (Topical) Outpatient Dosage Forms Outpatient Formulary Brands Available Anucort-HC; Proctozone-HC 2.5% Tablet, Oral: Outpatient Dosage Forms Generic: 2.5 mg [BCF], 5 mg [BCF] Cream, External, as base: Tablet, Micronized, Oral: Proctozone-HC 2.5%: 2.5% (30 g) [BCF] Generic: 3 mg [BCF], 5 mg [BCF] Generic: 1% (30 g), 2.5% (30 g) 8 ISOSORBIDE DINITRATE

Cream, External, as valerate: Outpatient Dosage Forms Generic: 0.2% (15 g, 45 g) Suspension, Subcutaneous: Ointment, External, as base: NovoLOG Mix 70/30: Insulin aspart protamine suspension 70% [intermediate Generic: 1% (30 g) acting] and insulin aspart solution 30% [rapid-acting]: 100 units/mL (10 mL) Ointment, External, as valerate: NovoLOG Mix 70/30 FlexPen: 100 units/mL: Insulin aspart protamine suspen- Generic: 0.2% (15 g) sion 70% [intermediate acting] and insulin aspart solution 30% [rapid-acting] Suppository, Rectal, as acetate: (3 mL) [BCF] Anucort-HC: 25 mg (12s) [BCF] Generic: 25 mg (12s) [BCF] Insulin Glargine Outpatient Formulary Brands Available Lantus; Lantus SoloStar Hydroxychloroquine Outpatient Dosage Forms Outpatient Dosage Forms Solution, Subcutaneous: Tablet, Oral, as sulfate: Lantus: 100 units/mL (10 mL) [contains metacresol] [BCF] Generic: 200 mg [equivalent to 155 mg base] Solution Pen-injector, Subcutaneous: HydrOXYzine Lantus Solostar: 100 units/mL (3 mL) [BCF] Outpatient Dosage Forms Insulin NPH Capsule, Oral, as pamoate: Generic: 25 mg, 50 mg Outpatient Formulary Brands Available NovoLIN N Solution, Oral, as hydrochloride: Outpatient Dosage Forms Generic: 10 mg/5 mL (473 mL) [BCF] Suspension, Subcutaneous: Syrup, Oral, as hydrochloride: NovoLIN N: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF] Generic: 10 mg/5 mL (118 mL, 473 mL) [BCF] Insulin NPH and Insulin Regular Tablet, Oral, as hydrochloride: Generic: 10 mg [BCF], 25 mg [BCF], 50 mg [BCF] Outpatient Formulary Brands Available HumuLIN 70/30; NovoLIN 70/30 Outpatient Dosage Forms Hyoscyamine Suspension, Subcutaneous: Outpatient Dosage Forms HumuLIN 70/30: 100 units/mL: Insulin NPH suspension 70% [intermediate Tablet, Oral, as sulfate: acting] and insulin regular solution 30% [short-acting] (3 mL, 10 mL) Generic: 0.125 mg NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulin regular solution 30% [short acting]: 100 units/mL (10 mL) [contains meta- Hyoscyamine, Atropine, Scopolamine, and Phenobarbital cresol, phenol] [BCF] Outpatient Formulary Brands Available Donnatal Outpatient Dosage Forms Insulin Regular Elixir, Oral: Outpatient Formulary Brands Available NovoLIN R Donnatal: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, sco- Outpatient Dosage Forms polamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL Solution, Injection: (118 mL) [contains ethanol <23.8%; grape flavor] NovoLIN R: 100 units/mL (10 mL) [contains metacresol] [BCF] Generic: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, scopolamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL Interferon Beta-1b (120 mL) Outpatient Formulary Brands Available Betaseron Ibandronate Outpatient Dosage Forms Kit, Subcutaneous: Outpatient Dosage Forms Betaseron: 0.3 mg [contains albumin human] [BCF] Tablet, Oral: Generic: 150 mg Ipratropium and Albuterol Ibuprofen Outpatient Formulary Brands Available Combivent Outpatient Dosage Forms Outpatient Dosage Forms Suspension, Oral: Solution, for Nebulization: Generic: 100 mg/5 mL (120 mL) DuoNeb: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL Tablet, Oral: (30s, 60s) [BCF] Generic: 400 mg [BCF], 600 mg [BCF], 800 mg [BCF] Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL (30s, 60s) [BCF] Imipramine Solution, for Oral Inhalation [spray]: Outpatient Dosage Forms Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100 Capsule, Oral, as pamoate: mcg per inhalation (4 g) [contains benzalkonium chloride] [BCF] Generic: 75 mg [BCF] Tablet, Oral, as hydrochloride: Ipratropium (Nasal) Generic: 10 mg [BCF], 50 mg [BCF] Outpatient Formulary Brands Available Atrovent Outpatient Dosage Forms Imiquimod Solution, Nasal, as bromide: Outpatient Dosage Forms Atrovent: 0.06% (15 mL [DSC]) Cream, External: Generic: 0.03% (30 mL); 0.06% (15 mL) Generic: 5% (24 ea) [0.25 g/packet] Ipratropium (Oral Inhalation) Indomethacin Outpatient Formulary Brands Available Atrovent HFA Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Aerosol Solution, Inhalation, as bromide: Generic: 25 mg [BCF], 50 mg [BCF] Atrovent HFA: 17 mcg/actuation (12.9 g) [contains alcohol, usp] [BCF] Inhalation Devices Solution, Inhalation, as bromide: Outpatient Formulary Brands Available AeroChamber; OptiChamber; Generic: 0.02% (2.5 mL) [BCF] OptiHaler Isoniazid Outpatient Dosage Forms Outpatient Dosage Forms Holding chamber with mask: Solution, Oral: Adult Generic: 50 mg/5 mL (473 mL) Pediatric: Small, medium, large Tablet, Oral: Insulin Aspart Generic: 100 mg [BCF] Outpatient Formulary Brands Available NovoLOG; NovoLOG FlexPen Isosorbide Dinitrate Outpatient Dosage Forms Outpatient Formulary Brands Available Dilatrate-SR Solution, Subcutaneous: NovoLOG: 100 units/mL (10 mL) [contains metacresol, phenol] [BCF] Outpatient Dosage Forms Solution Pen-injector, Subcutaneous: Capsule Extended Release, Oral: NovoLOG FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] [BCF] Dilatrate-SR: 40 mg Tablet, Oral: Insulin Aspart Protamine and Insulin Aspart Generic: 5 mg [BCF] Outpatient Formulary Brands Available NovoLOG Mix 70/30; NovoLOG Tablet, Extended Release, Oral: Mix 70/30 FlexPen Generic: 40 mg [BCF] 9 ISOSORBIDE MONONITRATE Isosorbide Mononitrate Outpatient Dosage Forms Outpatient Dosage Forms Jelly, External, as hydrochloride: Tablet, Oral: Xylocaine: 2% (30 mL) Generic: 20 mg Ointment, External: Generic: 5% (30 g, 50 g) Ketoconazole (Systemic) Patch, External: Outpatient Dosage Forms Generic: 5% (1 ea, 30 ea) Tablet, Oral: Solution, Mouth/Throat, as hydrochloride: Generic: 200 mg Generic: 2% (100 mL) Ketoconazole (Topical) LinaCLOtide Outpatient Dosage Forms Outpatient Formulary Brands Available Linzess Cream, External: Outpatient Dosage Forms Generic: 2% (15 g) Capsule, Oral: Shampoo, External: Linzess: 145 mcg, 290 mcg Generic: 2% (120 mL) Liraglutide Lactic Acid and Ammonium Hydroxide Outpatient Formulary Brands Available Victoza Outpatient Formulary Brands Available AmLactin [OTC] Outpatient Dosage Forms Outpatient Dosage Forms Solution Pen-injector, Subcutaneous: Lotion, External: Victoza: 18 mg/3 mL (3 mL) [contains phenol, propylene glycol] AmLactin: Lactic acid 12% with ammonium hydroxide (225 g) Lisinopril Generic: Lactic acid 12% with ammonium hydroxide (225 g) Outpatient Dosage Forms Lactobacillus Tablet, Oral: Outpatient Dosage Forms Generic: 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 30 mg Capsule, Oral: [BCF], 40 mg [BCF] Culturelle: L. rhamnosus GG 10 billion colony-forming units Lisinopril and Hydrochlorothiazide Packet, Oral: Outpatient Dosage Forms Culturelle Kids Tablet, Oral: Lactulose Generic: Outpatient Dosage Forms 10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg [BCF] Solution, Oral: 20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg [BCF] Generic: 10 g/15 mL (15 mL, 30 mL, 237 mL, 473 mL, 500 mL, 946 mL, 1892 20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg [BCF] mL) [BCF] Lithium Solution, Oral/Rectal: Outpatient Dosage Forms Generic: 10 g/15 mL (237 mL, 473 mL, 946 mL) [BCF] Capsule, Oral, as carbonate: LamoTRIgine Generic: 150 mg [BCF], 300 mg [BCF] Outpatient Dosage Forms Solution, Oral, as citrate: Generic: 300 mg/5 mL (500 mL) [equivalent to amount of lithium in lithium Tablet, Oral: carbonate] [BCF] Generic: 25 mg Latanoprost Loperamide Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral, as hydrochloride: Solution, Ophthalmic: Generic: 2 mg [BCF] Generic: 0.005% (2.5 mL) [BCF] LevETIRAcetam Loratadine Outpatient Dosage Forms Outpatient Dosage Forms Syrup, Oral: Solution, Oral: Generic: 5 mg/5 mL (120 mL) Generic: 100 mg/mL (5 mL, 473 mL, 500 mL) Tablet, Oral: Tablet, Oral: Generic: 10 mg Generic: 250 mg, 500 mg, 750 mg, 1000 mg Tablet Extended Release 24 Hour, Oral: LORazepam Generic: 500 mg, 750 mg Outpatient Dosage Forms LevoFLOXacin (Systemic) Tablet, Oral: Generic: 0.5 mg, 1 mg Outpatient Formulary Brands Available Levaquin Outpatient Dosage Forms Losartan Solution, Oral: Outpatient Formulary Brands Available Cozaar Levaquin: 25 mg/mL (480 mL) [contains benzyl alcohol, propylene gly- Outpatient Dosage Forms col] [BCF] Tablet, Oral, as potassium: Generic: 25 mg/mL (480 mL) [BCF] Cozaar: 25 mg [contains potassium 2.12 mg (0.054 mEq)] [BCF] Tablet, Oral: Cozaar: 50 mg [contains potassium 4.24 mg (0.108 mEq)] [BCF] Levaquin: 250 mg [BCF] Cozaar: 100 mg [contains potassium 8.48 mg (0.216 mEq)] [BCF] Generic: 250 mg [BCF] Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Levonorgestrel (Systemic) Losartan and Hydrochlorothiazide Outpatient Formulary Brands Available Plan B Outpatient Formulary Brands Available Hyzaar Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Plan B: 0.75 mg [BCF] Hyzaar: 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [con- Levothyroxine tains potassium 4.24 mg (0.108 mEq)] [BCF] Outpatient Formulary Brands Available Synthroid 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide 12.5 mg Outpatient Dosage Forms [contains potassium 8.48 mg (0.216 mEq)] [BCF] Tablet, Oral, as sodium: 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [con- Synthroid: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 tains potassium 8.48 mg (0.216 mEq)] [BCF] mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg Generic: [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF] 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg [BCF] Generic: 25 mcg [BCF], 50 mcg [BCF], 75 mcg [BCF], 88 mcg [BCF], 100 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide mcg [BCF], 112 mcg [BCF], 125 mcg [BCF], 137 mcg [BCF], 150 mcg 12.5 mg [BCF] [BCF], 175 mcg [BCF], 200 mcg [BCF], 300 mcg [BCF] 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg [BCF] Lidocaine (Topical) Lubiprostone Outpatient Formulary Brands Available Xylocaine Outpatient Formulary Brands Available Amitiza 10 MORPHINE (SYSTEMIC)

Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral, as succinate: Capsule, Oral: Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF] Amitiza: 8 mcg, 24 mcg MetroNIDAZOLE (Systemic) MedroxyPROGESTERone Outpatient Dosage Forms Outpatient Formulary Brands Available Depo-Provera; Provera Tablet, Oral: Outpatient Dosage Forms Generic: 250 mg [BCF], 500 mg [BCF] Suspension, Intramuscular, as acetate: Depo-Provera: 150 mg/mL (1 mL) [contains polysorbate 80] MetroNIDAZOLE (Topical) Generic: 150 mg/mL (1 mL) Outpatient Formulary Brands Available MetroGel; MetroGel-Vaginal; Van- Tablet, Oral, as acetate: dazole Provera: 10 mg [BCF] [scored] Outpatient Dosage Forms Generic: 10 mg [BCF] Gel, External: MetroGel: 1% (60 g) Megestrol Generic: 1% (60 g) Outpatient Dosage Forms Gel, Vaginal: Tablet, Oral, as acetate: MetroGel-Vaginal: 0.75% (70 g) [BCF] Generic: 40 mg Vandazole: 0.75% (70 g) [BCF] Generic: 0.75% (70 g) [BCF] Meloxicam Outpatient Dosage Forms Miconazole (Topical) Tablet, Oral: Outpatient Formulary Brands Available Zeasorb-AF [OTC] Generic: 7.5 mg [BCF], 15 mg [BCF] Outpatient Dosage Forms Memantine Cream, Vaginal, as nitrate: Generic: 2% (45 g) Outpatient Formulary Brands Available Namenda XR Powder, External, as nitrate: Outpatient Dosage Forms Zeasorb-AF: 2% (70 g) Capsule Extended Release 24 Hour, Oral, as hydrochloride: Namenda XR: 28 mg Minocycline (Systemic) Generic: 28 mg Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Capsule, Oral: Generic: 5 mg, 10 mg Generic: 50 mg, 100 mg Mesalamine Minoxidil (Systemic) Outpatient Formulary Brands Available Lialda Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet Delayed Release, Oral: Generic: 2.5 mg, 10 mg Lialda: 1.2 g [BCF] Generic: 1.2 g [BCF] Mirabegron Outpatient Formulary Brands Available Myrbetriq MetFORMIN Outpatient Dosage Forms Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral: Tablet, Oral, as hydrochloride: Myrbetriq: 25 mg, 50 mg Generic: 1.2 g [BCF] 500 mg [BCF], 850 mg [BCF], 1000 mg [BCF] Tablet Extended Release 24 Hour, Oral, as hydrochloride: Mirtazapine Generic: 1.2 g [BCF] 500 mg [BCF], 750 mg [BCF] Outpatient Dosage Forms Methocarbamol Tablet, Oral: Generic: 15 mg, 30 mg, 45 mg Outpatient Dosage Forms Tablet, Oral: MiSOPROStol Generic: 500 mg [BCF] Outpatient Dosage Forms Methotrexate Tablet, Oral: Outpatient Dosage Forms Generic: 200 mcg Tablet, Oral: Modafinil Generic: 2.5 mg [BCF] Outpatient Dosage Forms Methylphenidate Tablet, Oral: Outpatient Formulary Brands Available Concerta; Metadate CD Generic: 100 mg, 200 mg Outpatient Dosage Forms Mometasone (Nasal) Capsule Extended Release, Oral, as hydrochloride: Outpatient Dosage Forms Metadate CD: 20 mg [contains sucrose; 6 mg immediate release, 14 mg Suspension, Nasal, as furoate: extended release] Generic: 50 mcg/actuation (17 g) Generic: 20 mg Tablet, Oral, as hydrochloride: Mometasone (Oral Inhalation) Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF] Outpatient Formulary Brands Available Asmanex Tablet Extended Release 24 Hour, Oral, as hydrochloride: Outpatient Dosage Forms Concerta: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF] Aerosol Powder Breath Activated, Inhalation, as furoate: Generic: 18 mg [BCF], 27 mg [BCF], 36 mg [BCF], 54 mg [BCF] Asmanex 30 Metered Doses: 110 mcg/INH (1 ea) [contains milk protein] MethylPREDNISolone Asmanex 60 Metered Doses: 220 mcg/INH (1 ea) [contains milk protein] Outpatient Dosage Forms Montelukast Tablet Therapy Pack, Oral: Outpatient Formulary Brands Available Singulair Generic: 4 mg (21 ea) Outpatient Dosage Forms Metoclopramide Packet, Oral: Outpatient Dosage Forms Singulair: 4 mg/packet (30s) [BCF] Tablet, Oral: Generic: 4 mg/packet (1s, 30s) [BCF] Generic: 10 mg [BCF] Tablet, Oral: Singulair: 10 mg [contains lactose 89.3 mg/tablet] [BCF] MetOLazone Generic: 10 mg [BCF] Outpatient Dosage Forms Tablet, Chewable, Oral: Tablet, Oral: Singulair: Generic: 2.5 mg, 5 mg 4 mg [contains phenylalanine 0.674 mg/tablet; cherry flavor] [BCF] 5 mg [contains phenylalanine 0.842 mg/tablet; cherry flavor] [BCF] Metoprolol Generic: 4 mg [BCF], 5 mg [BCF] Outpatient Dosage Forms Tablet, Oral, as tartrate: Morphine (Systemic) Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Outpatient Formulary Brands Available MS Contin 11 MORPHINE (SYSTEMIC)

Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as sulfate: Patch 24 Hour, Transdermal: Generic: 15 mg Generic: 0.1 mg/hour (30s) [BCF]; 0.2 mg/hour (30s) [BCF]; 0.4 mg/hour Tablet Extended Release, Oral, as sulfate: (30s) [BCF]; 0.6 mg/hour (30s) [BCF] MS Contin: 15 mg [BCF] Solution, Translingual: Generic: 15 mg [BCF], 30 mg [BCF], 60 mg [BCF], 100 mg [BCF], Nitrolingual: 200 mg [BCF] 0.4 mg/spray (4.9 g) [contains ethanol 20%; 60 metered sprays] [BCF] Moxifloxacin (Ophthalmic) 0.4 mg/spray (12 g) [contains ethanol 20%; 200 metered sprays] [BCF] Generic: 0.4 mg/spray (4.9 g, 12 g) [BCF] Outpatient Dosage Forms Tablet, Sublingual: Solution, Ophthalmic: Nitrostat: 0.4 mg [BCF] Generic: 0.5% (3 mL) Mupirocin Norethindrone Outpatient Dosage Forms Outpatient Formulary Brands Available Aygestin; Nor-QD Ointment, External: Outpatient Dosage Forms Generic: 2% (22 g) [BCF] Tablet, Oral: Nor-QD: 0.35 mg [BCF] Naloxone Generic: 0.35 mg [BCF] Outpatient Formulary Brands Available Narcan Tablet, Oral, as acetate: Outpatient Dosage Forms Aygestin: 5 mg [scored] Liquid, Nasal: Generic: 5 mg Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetate disodium] Nortriptyline Outpatient Dosage Forms Naphazoline and Pheniramine Capsule, Oral: Outpatient Formulary Brands Available Naphcon-A [OTC] Generic: 10 mg [BCF], 25 mg [BCF] Outpatient Dosage Forms Solution, Ophthalmic: Nystatin and Triamcinolone Naphcon-A: Naphazoline hydrochloride 0.025% and pheniramine maleate Outpatient Dosage Forms 0.3% (15 mL) [contains benzalkonium chloride] Cream, External: Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% Naproxen (15 g, 60 g) Outpatient Dosage Forms Ointment, External: Tablet, Oral: Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g) Generic: 250 mg [BCF], 500 mg [BCF] Tablet, Oral, as sodium: Nystatin (Oral) Generic: 550 mg Outpatient Dosage Forms Neomycin, Polymyxin B, and Gramicidin Suspension, Mouth/Throat: Generic: 100,000 units/mL (60 mL) [BCF] Outpatient Formulary Brands Available Neosporin Ophthalmic Solution Outpatient Dosage Forms Nystatin (Topical) Solution, Ophthalmic: Outpatient Formulary Brands Available Nystop Neosporin Ophthalmic Solution: Neomycin 1.75 mg, polymyxin B 10,000 units, Outpatient Dosage Forms and gramicidin 0.025 mg per 1 mL (10 mL) [BCF] Cream, External: Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin Generic: 100,000 units/g (30 g) [BCF] 0.025 mg per 1 mL (10 mL) [BCF] Ointment, External: Neomycin, Polymyxin B, and Hydrocortisone (Otic) Generic: 100,000 units/g (15 g) [BCF] Outpatient Dosage Forms Powder, External: Suspension, Otic: Nystop: 100,000 units/g (15 g) [contains talc] Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone Generic: 100,000 units/g (15 g) 10 mg per 1 mL (10 mL) [BCF] Ofloxacin (Otic) Niacin Outpatient Dosage Forms Outpatient Formulary Brands Available Niaspan Solution, Otic: Outpatient Dosage Forms Generic: 0.3% (5 mL, 10 mL) Tablet Extended Release, Oral: Niaspan: 500 mg [BCF], 1000 mg [BCF] Olmesartan Outpatient Formulary Brands Available Benicar NIFEdipine Outpatient Dosage Forms Outpatient Formulary Brands Available Adalat CC; Afeditab CR; Procardia Tablet, Oral, as medoxomil: Outpatient Dosage Forms Benicar: 5 mg, 20 mg, 40 mg Capsule, Oral: Generic: 5 mg, 20 mg, 40 mg Procardia: 10 mg Generic: 10 mg Olmesartan and Hydrochlorothiazide Tablet Extended Release 24 Hour, Oral: Outpatient Formulary Brands Available Benicar HCT Adalat CC: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF] Outpatient Dosage Forms Afeditab CR: 30 mg [BCF], 60 mg [BCF] Tablet, Oral: Generic: 30 mg [BCF], 60 mg [BCF], 90 mg [BCF] Benicar HCT: Nisoldipine 20/12.5: Olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mg 40/12.5: Olmesartan medoxomil 40 mg and hydrochlorothiazide 12.5 mg Outpatient Formulary Brands Available Sular 40/25: Olmesartan medoxomil 40 mg and hydrochlorothiazide 25 mg Outpatient Dosage Forms Generic: 20/12.5: Olmesartan 20 mg and hydrochlorothiazide 12.5 mg; Tablet Extended Release 24 Hour, Oral: 40/12.5: Olmesartan 40 mg and hydrochlorothiazide 12.5 mg; 40/25: Olme- Sular: 8.5 mg, 25.5 mg Sular: 17 mg [contains tartrazine (fd&c yellow #5)] sartan 40 mg and hydrochlorothiazide 25 mg Generic: 8.5 mg, 17 mg, 25.5 mg Olopatadine (Ophthalmic) Nitrofurantoin Outpatient Formulary Brands Available Pataday; Patanol Outpatient Formulary Brands Available Macrodantin Outpatient Dosage Forms Outpatient Dosage Forms Solution, Ophthalmic: Capsule, Oral, as macrocrystals: Pataday: 0.2% (2.5 mL) [contains benzalkonium chloride] Macrodantin: 50 mg [BCF] Patanol: 0.1% (5 mL) [contains benzalkonium chloride] [BCF] Generic: 50 mg [BCF], 100 mg Generic: 0.1% (5 mL); 0.2% (2.5 mL) Capsule, Oral [macrocrystal/monohydrate]: Generic: 100 mg [BCF] Omega-3 Fatty Acids Outpatient Dosage Forms Nitroglycerin Capsule, Oral: Outpatient Formulary Brands Available Nitrolingual; Nitrostat Generic: 1 g 12 PRAMOXINE AND HYDROCORTISONE Omeprazole Phenytoin Outpatient Dosage Forms Outpatient Formulary Brands Available Dilantin Capsule Delayed Release, Oral: Outpatient Dosage Forms Generic: 10 mg [BCF], 20 mg [BCF] Capsule, Oral, as sodium: Dilantin: 100 mg [BCF] Ondansetron Generic: 100 mg [BCF] Outpatient Dosage Forms Solution, Oral, as hydrochloride [strength expressed as base]: Pilocarpine (Ophthalmic) Generic: 4 mg/5 mL (50 mL) Outpatient Dosage Forms Tablet, Oral: Solution, Ophthalmic, as hydrochloride: Generic: 4 mg, 8 mg Generic: 2% (15 mL) [BCF]; 4% (15 mL) [BCF] Tablet Disintegrating, Oral: Generic: 4 mg, 8 mg Pimecrolimus Outpatient Formulary Brands Available Elidel Oseltamivir Outpatient Dosage Forms Outpatient Formulary Brands Available Tamiflu Cream, External: Outpatient Dosage Forms Elidel: 1% (30 g) [BCF] Capsule, Oral, as phosphate: Generic: 1% (30 g) [BCF] Tamiflu: 75 mg Generic: 75 mg Pioglitazone OXcarbazepine Outpatient Formulary Brands Available Actos Outpatient Dosage Forms Outpatient Formulary Brands Available Trileptal Tablet, Oral: Outpatient Dosage Forms Actos: 15 mg, 30 mg, 45 mg Suspension, Oral: Generic: 15 mg, 30 mg, 45 mg Trileptal: 300 mg/5 mL (250 mL) [contains ethanol, propylene glycol] Generic: 300 mg/5 mL (250 mL) Piroxicam (Systemic) Tablet, Oral: Outpatient Dosage Forms Trileptal: 150 mg, 300 mg, 600 mg [scored] Capsule, Oral: Generic: 150 mg, 300 mg, 600 mg Generic: 20 mg Oxybutynin Polyethylene Glycol 3350 Outpatient Formulary Brands Available Ditropan XL Outpatient Dosage Forms Outpatient Dosage Forms Powder, Oral: Tablet, Oral, as chloride: Generic: 17 g/dose (255 g, 527 g) Generic: 5 mg Tablet Extended Release 24 Hour, Oral, as chloride: Polyethylene Glycol-Electrolyte Solution Ditropan XL: 5 mg [BCF], 10 mg [BCF] Outpatient Formulary Brands Available Colyte; MoviPrep; NuLYTELY; Generic: 5 mg [BCF], 10 mg [BCF], 15 mg [BCF] Plenvu Oxycodone and Acetaminophen Outpatient Dosage Forms Powder for Solution, Oral: Outpatient Formulary Brands Available Percocet; Roxicet Colyte: PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, Outpatient Dosage Forms sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL) [available Tablet, Oral: with lemon lime, cherry, and orange flavor packets] Percocet: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg [scored] [BCF] MoviPrep: Pouch A: PEG 3350 100g, sodium sulfate 7.5 g, sodium chloride Roxicet: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg 2.69 g, potassium chloride 1.02 g; Pouch B: Ascorbic acid 4.7 g, sodium [scored] [BCF] ascorbate 5.9 g (1000 mL) [contains phenylalanine 233 mg/treatment; lemon Generic: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen flavor; packaged with 2 of Pouch A and 2 of Pouch B in carton and a 325 mg [BCF] disposable reconstitution container] NuLYTELY: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride Oxymetazoline (Nasal) 11.2 g, and potassium chloride 1.48 g (4000 mL) [supplied with cherry, Outpatient Dosage Forms lemon-lime, orange, and pineapple flavor packs] Solution, Nasal, as hydrochloride: Plenvu: Dose 1: PEG 3350 100 g, sodium sulfate 9 g, sodium chloride 2 g, Generic: 0.05% (15 mL) potassium chloride 1 g [mango flavor; makes 473 mL of solution after mixing]; Dose 2, Pouch A: PEG 3350 40 g, sodium chloride 3.2 g, potassium Pantoprazole chloride 1.2 g; Dose 2, Pouch B: sodium ascorbate 48.11 g, ascorbic acid Outpatient Dosage Forms 7.54 g [contains phenylalanine 491 mg/treatment; fruit punch flavor; makes Tablet Delayed Release, Oral: 473 mL of solution after mixing] Generic: 20 mg, 40 mg Generic: PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate PARoxetine 6.72 g, sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL); PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, and Outpatient Dosage Forms potassium chloride 1.48 g (4000 mL) Tablet, Oral, as hydrochloride [strength expressed as base]: Generic: 20 mg, 30 mg Potassium Chloride Penicillin V Potassium Outpatient Formulary Brands Available Klor-Con; Klor-Con 10; Klor-Con M10; Klor-Con M20 Outpatient Dosage Forms Outpatient Dosage Forms Solution Reconstituted, Oral: Packet, Oral: Generic: 250 mg/5 mL (200 mL) [BCF] Klor-Con: 20 mEq/packet (30s) [sugar free; fruit flavor] [BCF] Tablet, Oral: Generic: 250 mg [BCF], 500 mg [BCF] Generic: 20 mEq (30 ea) [BCF] Solution, Oral: Permethrin Generic: 20 mEq/15 mL (15 mL, 30 mL, 473 mL) [BCF] Outpatient Dosage Forms Tablet Extended Release, Oral: Cream, External: Klor-Con: 8 mEq [contains fd&c blue #1 aluminum lake, fd&c blue #2 Generic: 5% (60 g) [BCF] aluminum lake] Klor-Con 10: 10 mEq [BCF] Phenazopyridine Klor-Con M10: 10 mEq Outpatient Dosage Forms Klor-Con M20: 20 mEq [scored] [BCF] Tablet, Oral, as hydrochloride: Generic: 10 mEq [BCF], 20 mEq [BCF] Generic: 100 mg [BCF], 200 mg [BCF] Pramipexole PHENobarbital Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as dihydrochloride monohydrate: Elixir, Oral: Generic: 0.125 mg, 0.5 mg Generic: 20 mg/5 mL (5 mL, 7.5 mL, 15 mL) [BCF] Tablet, Oral: Pramoxine and Hydrocortisone Generic: 16.2 mg [BCF], 32.4 mg [BCF], 64.8 mg [BCF], 97.2 mg [BCF] Outpatient Formulary Brands Available ProctoFoam HC 13 PRAMOXINE AND HYDROCORTISONE

Outpatient Dosage Forms Outpatient Dosage Forms Aerosol, Foam, Rectal: Syrup, Oral, as hydrochloride: ProctoFoam HC: Pramoxine hydrochloride 1% and hydrocortisone acetate Generic: 30 mg/5 mL (118 mL) 1% (10 g) Tablet, Oral, as hydrochloride: SudoGest: 30 mg Pravastatin Generic: 30 mg Outpatient Dosage Forms Tablet, Oral, as sodium: Pyrethrins and Piperonyl Butoxide Generic: 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], 80 mg [BCF] Outpatient Formulary Brands Available RID Maximum Strength [OTC] Prazosin Outpatient Dosage Forms Shampoo, External: Outpatient Dosage Forms RID Maximum Strength: Pyrethrins 0.33% and piperonyl butoxide 4% (60 mL, Capsule, Oral, as hydrochloride: 120 mL, 180 mL, 240 mL) [packaged with nit removal comb; also available in Generic: 1 mg, 2 mg, 5 mg a kit containing shampoo, gel, and furniture spray] PrednisoLONE (Ophthalmic) Pyridoxine Outpatient Formulary Brands Available Pred Mild Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Suspension, Ophthalmic, as acetate: Generic: 50 mg Pred Mild: 0.12% (5 mL) [contains benzalkonium chloride, sodium bisul- fite] [BCF] QUEtiapine Generic: 1% (5 mL) [BCF] Outpatient Dosage Forms PrednisoLONE (Systemic) Tablet, Oral: Outpatient Formulary Brands Available Orapred ODT Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF], 200 mg [BCF], Outpatient Dosage Forms 300 mg [BCF] Solution, Oral, as sodium phosphate [strength expressed as base]: RABEprazole Generic: 15 mg/5 mL (237 mL, 473 mL) [BCF] Outpatient Dosage Forms Tablet Disintegrating, Oral, as sodium phosphate [strength expressed as base]: Tablet Delayed Release, Oral, as sodium: Orapred ODT: 10 mg, 15 mg, 30 mg [grape flavor] Generic: 20 mg Generic: 10 mg, 15 mg, 30 mg Raloxifene PredniSONE Outpatient Formulary Brands Available Evista Outpatient Dosage Forms Outpatient Dosage Forms Solution, Oral: Generic: 1 mg/mL (5 mL, 500 mL) Tablet, Oral, as hydrochloride: Tablet, Oral: Evista: 60 mg [BCF] Generic: 1 mg [BCF], 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 50 mg Generic: 60 mg [BCF] Primaquine Ramipril Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral, as phosphate: Capsule, Oral: Generic: 26.3 mg Generic: 1.25 mg [BCF], 2.5 mg [BCF], 5 mg [BCF], 10 mg [BCF] Primidone RaNITIdine (Withdrawn From US Market) Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Syrup, Oral: Generic: 50 mg, 250 mg Generic: 15 mg/mL (473 mL) [BCF] Tablet, Oral: Probenecid Generic: 150 mg [BCF] Outpatient Dosage Forms Tablet, Oral: Ranolazine Generic: 500 mg [BCF] Outpatient Formulary Brands Available Ranexa Outpatient Dosage Forms Prochlorperazine Tablet Extended Release 12 Hour, Oral: Outpatient Dosage Forms Ranexa: 500 mg, 1000 mg Tablet, Oral, as maleate [strength expressed as base]: Generic: 500 mg, 1000 mg Generic: 5 mg RifAMPin Progesterone Outpatient Dosage Forms Outpatient Dosage Forms Capsule, Oral: Capsule, Oral: Generic: 300 mg [BCF] Generic: 100 mg, 200 mg RisperiDONE Promethazine Outpatient Formulary Brands Available RisperDAL Outpatient Formulary Brands Available Promethegan Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Suppository, Rectal, as hydrochloride: RisperDAL: 3 mg [BCF], 4 mg [BCF] Promethegan: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF] Generic: 0.25 mg [BCF], 0.5 mg [BCF], 1 mg [BCF], 2 mg [BCF], 3 mg Generic: 12.5 mg (12s) [BCF]; 25 mg (12s) [BCF] [BCF], 4 mg [BCF] Syrup, Oral, as hydrochloride: Tablet Disintegrating, Oral: Generic: 6.25 mg/5 mL (118 mL) [BCF] Generic: 0.5 mg Tablet, Oral, as hydrochloride: Generic: 12.5 mg, 25 mg [BCF] Rivastigmine Propranolol Outpatient Dosage Forms Outpatient Dosage Forms Patch 24 Hour, Transdermal: Generic: 4.6 mg/24 hr (1 ea, 30 ea); 9.5 mg/24 hr (1 ea, 30 ea) Capsule Extended Release 24 Hour, Oral, as hydrochloride: Generic: 60 mg, 80 mg, 120 mg, 160 mg Rizatriptan Tablet, Oral, as hydrochloride: Outpatient Formulary Brands Available Maxalt; Maxalt-MLT Generic: 10 mg, 40 mg Outpatient Dosage Forms Propylthiouracil Tablet, Oral: Outpatient Dosage Forms Maxalt: 5 mg [BCF], 10 mg [BCF] Tablet, Oral: Generic: 5 mg [BCF], 10 mg [BCF] Generic: 50 mg [BCF] Tablet Dispersible, Oral: Maxalt-MLT: 5 mg [BCF],10 mg [BCF] [contains aspartame; peppermint Pseudoephedrine flavor] Outpatient Formulary Brands Available SudoGest [OTC] Generic: 5 mg [BCF], 10 mg [BCF] 14 TAZAROTENE ROPINIRole Outpatient Dosage Forms Outpatient Dosage Forms Ointment, Ophthalmic: Tablet, Oral: Generic: 5% (3.5 g) Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg Nebulization Solution, Inhalation [preservative free]: Generic: 0.9% (5 mL) Rosuvastatin Solution, Nasal: Outpatient Formulary Brands Available Crestor Deep Sea: 0.65% (45 mL) [contains benzalkonium chloride, benzyl alcohol] Outpatient Dosage Forms Generic: 0.65% (45 mL) Tablet, Oral: Crestor: 5 mg, 10 mg, 20 mg, 40 mg Sodium Phosphates Generic: 5 mg, 10 mg, 20 mg, 40 mg Outpatient Dosage Forms Solution, Rectal [enema]: Salicylic Acid Generic: Monobasic sodium phosphate 19 g and dibasic sodium phosphate Outpatient Formulary Brands Available DuoFilm [OTC] 7 g per 118 mL delivered dose (133 mL) Outpatient Dosage Forms Liquid, External: Sotalol DuoFilm: 17% (9.8 mL) [contains ethanol] Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Salmeterol Generic: 80 mg, 120 mg Outpatient Formulary Brands Available Serevent Diskus Outpatient Dosage Forms Spironolactone Aerosol Powder Breath Activated, Inhalation: Outpatient Dosage Forms Serevent Diskus: 50 mcg (60s) [contains lactose] [BCF] Tablet, Oral: Generic: 25 mg [BCF], 50 mg Scopolamine (Systemic) Outpatient Formulary Brands Available Transderm-Scop Sucralfate Outpatient Dosage Forms Outpatient Formulary Brands Available Carafate Patch 72 Hour, Transdermal: Outpatient Dosage Forms Transderm-Scop (1.5 MG): 1 MG/3DAYS (1 ea, 4 ea, 10 ea, 24 ea) Suspension, Oral: Carafate: 1 g/10 mL (420 mL) [contains methylparaben; cherry flavor] Selenium Sulfide Tablet, Oral: 1 g Outpatient Dosage Forms Lotion, External: Sulfacetamide (Ophthalmic) Generic: 2.5% (120 mL) [BCF] Outpatient Dosage Forms Sertraline Solution, Ophthalmic, as sodium: Generic: 10% (15 mL) [BCF] Outpatient Dosage Forms Tablet, Oral: Sulfacetamide (Topical) Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Outpatient Dosage Forms Sildenafil Lotion, External, as sodium: Generic: 10% (118 mL) Outpatient Formulary Brands Available Viagra Outpatient Dosage Forms Sulfamethoxazole and Trimethoprim Solution, Intravenous: Outpatient Dosage Forms Revatio: 10 mg/12.5 mL (12.5 mL) [ECF] Suspension, Oral: Generic: 10 mg/12.5 mL (12.5 mL) [ECF] Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (20 mL, Suspension Reconstituted, Oral: 473 mL) [BCF] Revatio: 10 mg/mL (112 mL) [contains sodium benzoate] [ECF] Tablet, Oral: Tablet, Oral: Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg [BCF], Sulame- Viagra: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] thoxazole 800 mg and trimethoprim 160 mg [BCF] Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] SulfaSALAzine Silver Sulfadiazine Outpatient Dosage Forms Outpatient Formulary Brands Available Silvadene; SSD Tablet, Oral: Outpatient Dosage Forms Generic: 500 mg [BCF] Cream, External: Tablet Delayed Release, Oral: Silvadene: 1% (20 g, 50 g, 85 g, 400 g, 1000 g) [BCF] Generic: 500 mg [BCF] SSD: 1% (25 g, 50 g, 85 g, 400 g) [BCF] Generic: 1% (20 g, 25 g, 50 g, 85 g, 400 g) [BCF] SUMAtriptan Simvastatin Outpatient Formulary Brands Available Imitrex Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Solution, Injection, as succinate [strength expressed as base]: Generic: 5 mg [BCF], 10 mg [BCF], 20 mg [BCF], 40 mg [BCF], Imitrex: 6 mg/0.5 mL (0.5 mL) [cartridge] [BCF] 80 mg [BCF] Generic: 6 mg/0.5 mL (0.5 mL) [BCF] Solution, Nasal: Sinus Rinse Generic: 20 mg/actuation (1 ea) Outpatient Formulary Brands Available NeilMed Sinus Rinse Tablet, Oral, as succinate [strength expressed as base]: Outpatient Dosage Forms Generic: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Solution, hypertonic nasal wash: NeilMed Sinus Rinse: Packet 50/box Tacrolimus (Topical) Outpatient Formulary Brands Available Protopic SITagliptin Outpatient Dosage Forms Outpatient Formulary Brands Available Januvia Ointment, External: Outpatient Dosage Forms Protopic: 0.03% (60 g); 0.1% (30 g) Tablet, Oral: Generic: 0.03% (60 g); 0.1% (30 g) Januvia: 25 mg [BCF], 50 mg [BCF], 100 mg [BCF] Tamoxifen Sitagliptin and Metformin Outpatient Dosage Forms Outpatient Formulary Brands Available Janumet Tablet, Oral: Outpatient Dosage Forms Generic: 10 mg [BCF], 20 mg [BCF] Tablet, Oral: Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride Tamsulosin 500 mg [BCF] Outpatient Dosage Forms Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride Capsule, Oral, as hydrochloride: 1000 mg [BCF] Generic: 0.4 mg [BCF] Sodium Chloride Tazarotene Outpatient Formulary Brands Available Deep Sea [OTC] Outpatient Formulary Brands Available Tazorac 15 TAZAROTENE

Outpatient Dosage Forms Solution, Ophthalmic, as maleate [strength expressed as base]: Cream, External: Timoptic: 0.25% (5 mL) [BCF]; 0.5% (5 mL, 10 mL) [BCF] [contains benzal- Tazorac: 0.05% (30 g); 0.1% (30 g) [contains benzyl alcohol] konium chloride] Gel, External: Generic: 0.25% (10 mL) [BCF]; 0.5% (10 mL) [BCF] Tazorac: 0.05% (30 g); 0.1% (30 g) [contains benzyl alcohol] Tiotropium Telmisartan Outpatient Formulary Brands Available Spiriva HandiHaler; Spiriva Respi- Outpatient Dosage Forms mat Tablet, Oral: Outpatient Dosage Forms Aerosol Solution, Inhalation:Spiriva Respimat: 2.5 Generic: 20 mg, 40 mg, 80 mg mcg/actuation (4 g) [contains benzalkonium chloride, disodium edta] Capsule, Inhalation: Telmisartan and Hydrochlorothiazide Spiriva HandiHaler: 18 mcg [contains milk protein] [BCF] Outpatient Formulary Brands Available Micardis HCT Outpatient Dosage Forms TiZANidine Tablet, Oral: Outpatient Dosage Forms Micardis HCT: Tablet, Oral: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mg Generic: 4 mg 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mg Tobramycin and Dexamethasone 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg Outpatient Formulary Brands Available TobraDex Generic: Outpatient Dosage Forms 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mg Ointment, Ophthalmic: 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mg TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g) [contains 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg chlorobutanol] Temazepam Suspension, Ophthalmic: Outpatient Dosage Forms Generic: Tobramycin 0.3% and dexamethasone 0.1% (5 mL) Capsule, Oral: Tobramycin (Ophthalmic) Generic: 15 mg [BCF], 30 mg [BCF] Outpatient Formulary Brands Available Tobrex Terazosin Outpatient Dosage Forms Outpatient Dosage Forms Ointment, Ophthalmic: Capsule, Oral: Tobrex: 0.3% (3.5 g) [contains chlorobutanol] Generic: 1 mg [BCF], 2 mg [BCF], 5 mg [BCF], 10 mg [BCF] Solution, Ophthalmic: Generic: 0.3% (5 mL) Terbinafine (Systemic) Outpatient Dosage Forms Tolterodine Tablet, Oral: Outpatient Formulary Brands Available Detrol LA Generic: 250 mg Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral, as tartrate: Terbinafine (Topical) Detrol LA: 2 mg [BCF], 4 mg [BCF] Outpatient Formulary Brands Available LamISIL AT [OTC] Generic: 2 mg [BCF], 4 mg [BCF] Outpatient Dosage Forms Topiramate Cream, External, as hydrochloride: Outpatient Formulary Brands Available Topamax LamISIL AT: 1% (30 g) [contains benzyl alcohol] Generic: 1% (30 g) Outpatient Dosage Forms Tablet, Oral: Terconazole Topamax: 25 mg, 50 mg, 100 mg, 200 mg Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg, 200 mg Cream, Vaginal: TraMADol Generic: 0.8% (20 g) Outpatient Dosage Forms Testosterone Tablet, Oral, as hydrochloride: Outpatient Formulary Brands Available Fortesta Generic: 50 mg [BCF] Outpatient Dosage Forms TraZODone Gel, Transdermal: Outpatient Dosage Forms Fortesta: 10 mg/actuation (2%) (60 g) [odorless; contains propylene glycol, Tablet, Oral, as hydrochloride: trolamine (triethanolamine)] [BCF] Generic: 50 mg [BCF], 100 mg [BCF], 150 mg [BCF], 300 mg [BCF] Generic: 10 mg/actuation (2%) (60 g) [BCF] Tretinoin (Topical) Theophylline Outpatient Formulary Brands Available Avita Outpatient Formulary Brands Available Theo-24 Outpatient Dosage Forms Outpatient Dosage Forms Cream, External: Capsule Extended Release 24 Hour, Oral: Avita: 0.025% (20 g) [BCF] Theo-24: 300 mg [BCF], 400 mg [BCF] Generic: 0.025% (20 g, 45 g) [BCF]; 0.05% (20 g) [BCF]; 0.1% (20 g) Solution, Oral: Gel, External: Generic: 80 mg/15 mL (473 mL) [BCF] Generic: 0.01% (15 g) Tablet, Extended Release, Oral: Generic: 200 mg [BCF], 300 mg [BCF], 400 mg [BCF] Triamcinolone (Topical) Outpatient Dosage Forms Thiamine Cream, External, as acetonide: Outpatient Dosage Forms Generic: 0.025% (15 g), 0.1% (15 g, 80 g, 454 g) [BCF]; 0.5% (15 g) Tablet, Oral, as hydrochloride: Ointment, External, as acetonide: Generic: 50 mg Generic: 0.1% (15 g) Paste, Mouth/Throat, as acetonide: Thyroid, Desiccated Generic: 0.1% (5 g) Outpatient Formulary Brands Available Nature-Throid Outpatient Dosage Forms Trimethoprim and Polymyxin B Tablet, Oral: Outpatient Dosage Forms Nature-Throid: 16.25 mg, 32.5 mg, 65 mg, 97.5 mg Solution, Ophthalmic: Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL Timolol (Ophthalmic) (10 mL) [BCF] Outpatient Formulary Brands Available Timolol GFS; Timoptic; Timoptic- XE Tropicamide Outpatient Dosage Forms Outpatient Formulary Brands Available Mydriacyl Gel Forming Solution, Ophthalmic, as maleate [strength expressed as base]: Outpatient Dosage Forms Timolol GFS: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF] Solution, Ophthalmic: Timoptic-XE: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF] Mydriacyl: 1% (15 mL) [contains benzalkonium chloride] Generic: 0.25% (5 mL) [BCF]; 0.5% (5 mL) [BCF] Generic: 1% (15 mL) 16 ZOLPIDEM ValACYclovir Verapamil Outpatient Dosage Forms Outpatient Dosage Forms Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 500 mg, 1 g Generic: 80 mg, 120 mg Tablet Extended Release, Oral, as hydrochloride: Valproic Acid and Derivatives Generic: 120 mg [BCF], 180 mg [BCF], 240 mg [BCF] Outpatient Formulary Brands Available Depakote; Depakote ER Outpatient Dosage Forms Vitamins (Multiple/Prenatal) Capsule Sprinkle, Oral, as divalproex sodium: Outpatient Dosage Forms Generic: 125 mg [BCF] Content varies depending on product used. Tablet Delayed Release, Oral, as divalproex sodium: Tablet, Oral: Depakote: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF] Generic: (100s) Generic: 125 mg [BCF], 250 mg [BCF], 500 mg [BCF] Tablet Extended Release 24 Hour, Oral, as divalproex sodium: Warfarin Depakote ER: 250 mg [BCF], 500 mg [BCF] Outpatient Formulary Brands Available Coumadin Generic: 250 mg [BCF], 500 mg [BCF] Outpatient Dosage Forms Tablet, Oral, as sodium: Valsartan Coumadin: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg Outpatient Dosage Forms [BCF], 5 mg [BCF], 6 mg [BCF], 7.5 mg [BCF], 10 mg [BCF] Tablet, Oral: Generic: 1 mg [BCF], 2 mg [BCF], 2.5 mg [BCF], 3 mg [BCF], 4 mg [BCF], Generic: 40 mg [BCF], 80 mg [BCF], 160 mg [BCF], 320 mg [BCF] 5 mg [BCF], 6 mg [BCF], 7.5 mg [BCF], 10 mg [BCF] Valsartan and Hydrochlorothiazide Zinc Oxide Outpatient Dosage Forms Outpatient Formulary Brands Available Boudreaux's Butt Paste [OTC] Tablet, Oral: Outpatient Dosage Forms Generic: Paste, External: 80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg [BCF] Boudreaux's Butt Paste: 16% (120 g) [contains castor oil, boric acid, mineral 160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg [BCF] oil, and Peruvian balsam] 160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg [BCF] 320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg [BCF] ZOLMitriptan 320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg [BCF] Outpatient Dosage Forms Solution, Nasal: Varenicline Zomig: 2.5 mg (6 ea); 5 mg (6 ea) Outpatient Dosage Forms Tablet, Oral: Tablet, Oral: Generic: 2.5 mg, 5 mg Chantix Starting Month Pak: 0.5 mg x 11 & 1 mg x 42 Tablet Dispersible, Oral: Generic: 2.5 mg Venlafaxine Outpatient Formulary Brands Available Effexor XR Zolpidem Outpatient Dosage Forms Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral: Tablet, Oral, as tartrate: Effexor XR: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF] Generic: 5 mg [BCF], 10 mg [BCF] Generic: 37.5 mg [BCF], 75 mg [BCF], 150 mg [BCF] Tablet Extended Release, Oral, as tartrate: Tablet Extended Release 24 Hour, Oral: Generic: 6.25 mg, 12.5 mg Generic: 225 mg [BCF]

17 Therapeutic Category Index

18 ACETYLCHOLINESTERASE INHIBITOR (CENTRAL)

Acetylcholinesterase Inhibitor (Central) Androgen Donepezil ...... 6 Testosterone ...... 16 Rivastigmine ...... 14 Anesthetic/Corticosteroid Acne Products Pramoxine and Hydrocortisone ...... 13 Benzoyl Peroxide ...... 3 Clindamycin and Benzoyl Peroxide ...... 4 Angiotensin II Receptor Blocker Erythromycin (Topical) ...... 6 Losartan ...... 10 Salicylic Acid ...... 15 Losartan and Hydrochlorothiazide ...... 10 Sulfacetamide (Topical) ...... 15 Olmesartan ...... 12 Tazarotene ...... 15 Olmesartan and Hydrochlorothiazide ...... 12 Tretinoin (Topical) ...... 16 Telmisartan ...... 16 Telmisartan and Hydrochlorothiazide ...... 16 Adrenergic Agonist Agent Valsartan ...... 17 Oxymetazoline (Nasal) ...... 13 Valsartan and Hydrochlorothiazide ...... 17 Alkylamine Derivative Angiotensin-Converting Enzyme (ACE) Inhibitor Hydrocodone and Chlorpheniramine ...... 8 Amlodipine and Benazepril ...... 2 Naphazoline and Pheniramine ...... 12 Captopril ...... 4 Lisinopril ...... 10 Alpha1 Agonist Lisinopril and Hydrochlorothiazide ...... 10 Naphazoline and Pheniramine ...... 12 Ramipril ...... 14 Alpha1 Blocker Antacid Alfuzosin ...... 2 Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone ...... 2 Doxazosin ...... 6 Prazosin ...... 14 Anthelmintic Tamsulosin ...... 15 Albendazole ...... 2 Terazosin ...... 16 Antianginal Agent Alpha2-Adrenergic Agonist AmLODIPine ...... 2 CloNIDine ...... 4 Amlodipine and Benazepril ...... 2 GuanFACINE ...... 8 Atenolol ...... 3 TiZANidine ...... 16 DilTIAZem ...... 5 Isosorbide Dinitrate ...... 9 Alpha2 Agonist, Ophthalmic Isosorbide Mononitrate ...... 10 Brimonidine (Ophthalmic) ...... 3 Metoprolol ...... 11 Alpha/Beta Agonist NIFEdipine ...... 12 EPINEPHrine (Systemic) ...... 6 Nitroglycerin ...... 12 Fexofenadine and Pseudoephedrine ...... 7 Propranolol ...... 14 Guaifenesin and Pseudoephedrine ...... 8 Ranolazine ...... 14 Pseudoephedrine ...... 14 Verapamil ...... 17 5 Alpha-Reductase Inhibitor Antianxiety Agent, Miscellaneous Finasteride ...... 7 BusPIRone ...... 3 Amebicide Antiarrhythmic Agent, Class Ic MetroNIDAZOLE (Systemic) ...... 11 Flecainide ...... 7 Aminoquinoline (Antimalarial) Antiarrhythmic Agent, Class II Hydroxychloroquine ...... 9 Propranolol ...... 14 Primaquine ...... 14 Sotalol ...... 15 5-Aminosalicylic Acid Derivative Antiarrhythmic Agent, Class III Mesalamine ...... 11 Amiodarone ...... 2 SulfaSALAzine ...... 15 Sotalol ...... 15 Ammonium Detoxicant Antiarrhythmic Agent, Class IV Lactulose ...... 10 DilTIAZem ...... 5 Verapamil ...... 17 Analgesic Combination (Opioid) Acetaminophen and Codeine ...... 2 Antiarrhythmic Agent, Miscellaneous Hydrocodone and Acetaminophen ...... 8 Digoxin ...... 5 Oxycodone and Acetaminophen ...... 13 Antibiotic, Aminoglycoside Analgesic, Nonopioid Gentamicin (Ophthalmic) ...... 8 Acetaminophen ...... 2 Tobramycin (Ophthalmic) ...... 16 Aspirin ...... 3 Antibiotic, Cephalosporin (First Generation) Butalbital, Acetaminophen, and Caffeine ...... 3 Cephalexin ...... 4 Celecoxib ...... 4 Diclofenac (Systemic) ...... 5 Antibiotic, Cephalosporin (Second Generation) Ibuprofen ...... 9 Cefprozil ...... 4 Indomethacin ...... 9 Cefuroxime ...... 4 Meloxicam ...... 11 Antibiotic, Cephalosporin (Third Generation) Naproxen ...... 12 Cefdinir ...... 4 Piroxicam (Systemic) ...... 13 Antibiotic/Corticosteroid, Ophthalmic Analgesic, Opioid Tobramycin and Dexamethasone ...... 16 Acetaminophen and Codeine ...... 2 Hydrocodone and Acetaminophen ...... 8 Antibiotic/Corticosteroid, Otic Hydrocodone and Chlorpheniramine ...... 8 Ciprofloxacin and Dexamethasone ...... 4 Morphine (Systemic) ...... 11 Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 12 Oxycodone and Acetaminophen ...... 13 TraMADol ...... 16 Antibiotic, Fluoroquinolone Ciprofloxacin (Systemic) ...... 4 Analgesic, Topical LevoFLOXacin (Systemic) ...... 10 Benzocaine ...... 3 Moxifloxacin (Ophthalmic) ...... 12 Capsaicin ...... 4 Ofloxacin (Otic) ...... 12 Lidocaine (Topical) ...... 10 Antibiotic, Lincosamide Analgesic, Urinary Clindamycin (Systemic) ...... 4 Phenazopyridine ...... 13 Clindamycin (Topical) ...... 4 19 ANTIFUNGAL AGENT, AZOLE DERIVATIVE

Antibiotic, Macrolide Anticonvulsant, Hydantoin Azithromycin (Systemic) ...... 3 Phenytoin ...... 13 Clarithromycin ...... 4 Erythromycin (Ophthalmic) ...... 6 Anticonvulsant, Miscellaneous Erythromycin (Systemic) ...... 6 AcetaZOLAMIDE ...... 2 Erythromycin (Topical) ...... 6 Gabapentin ...... 8 LamoTRIgine ...... 10 Antibiotic, Miscellaneous LevETIRAcetam ...... 10 MetroNIDAZOLE (Systemic) ...... 11 OXcarbazepine ...... 13 Nitrofurantoin ...... 12 Primidone ...... 14 Sulfamethoxazole and Trimethoprim ...... 15 Topiramate ...... 16 Antibiotic, Ophthalmic Valproic Acid and Derivatives ...... 17 Bacitracin and Polymyxin B (Ophthalmic) ...... 3 Antidepressant, Alpha-2 Antagonist Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) ...... 3 Mirtazapine ...... 11 Erythromycin (Ophthalmic) ...... 6 Gentamicin (Ophthalmic) ...... 8 Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor Moxifloxacin (Ophthalmic) ...... 12 BuPROPion ...... 3 Neomycin, Polymyxin B, and Gramicidin ...... 12 Sulfacetamide (Ophthalmic) ...... 15 Antidepressant, Selective Serotonin Reuptake Inhibitor Tobramycin (Ophthalmic) ...... 16 Citalopram ...... 4 Trimethoprim and Polymyxin B ...... 16 Escitalopram ...... 6 FLUoxetine ...... 7 Antibiotic, Oral Rinse PARoxetine ...... 13 Chlorhexidine Gluconate (Oral) ...... 4 Sertraline ...... 15 Antibiotic, Otic Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor Ciprofloxacin and Dexamethasone ...... 4 Venlafaxine ...... 17 Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 12 Ofloxacin (Otic) ...... 12 Antidepressant, Serotonin Reuptake Inhibitor/Antagonist TraZODone ...... 16 Antibiotic, Penicillin Amoxicillin ...... 2 Antidepressant, Tricyclic (Secondary Amine) Amoxicillin and Clavulanate ...... 2 Desipramine ...... 5 Dicloxacillin ...... 5 Nortriptyline ...... 12 Penicillin V Potassium ...... 13 Antidepressant, Tricyclic (Tertiary Amine) Antibiotic, Respiratory Fluoroquinolone Amitriptyline ...... 2 LevoFLOXacin (Systemic) ...... 10 Doxepin (Systemic) ...... 6 Antibiotic, Sulfonamide Derivative Imipramine ...... 9 Sulfacetamide (Topical) ...... 15 Antidiabetic Agent, Alpha-Glucosidase Inhibitor Sulfamethoxazole and Trimethoprim ...... 15 Acarbose ...... 2 Antibiotic, Tetracycline Derivative Antidiabetic Agent, Biguanide Doxycycline ...... 6 MetFORMIN ...... 11 Minocycline (Systemic) ...... 11 Sitagliptin and Metformin ...... 15 Antibiotic, Topical Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor Erythromycin (Topical) ...... 6 SITagliptin ...... 15 MetroNIDAZOLE (Topical) ...... 11 Sitagliptin and Metformin ...... 15 Mupirocin ...... 12 Silver Sulfadiazine ...... 15 Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Anticholinergic Agent Agonist Benztropine ...... 3 Exenatide ...... 7 Dicyclomine ...... 5 Liraglutide ...... 10 Hyoscyamine ...... 9 Antidiabetic Agent, Sulfonylurea Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ...... 9 Glimepiride ...... 8 Ipratropium and Albuterol ...... 9 GlipiZIDE ...... 8 Ipratropium (Nasal) ...... 9 GlyBURIDE ...... 8 Ipratropium (Oral Inhalation) ...... 9 Scopolamine (Systemic) ...... 15 Antidiabetic Agent, Thiazolidinedione Tiotropium ...... 16 Pioglitazone ...... 13 Tolterodine ...... 16 Antidiarrheal Anticholinergic Agent, Long-Acting Bismuth Subsalicylate ...... 3 Tiotropium ...... 16 Loperamide ...... 10 Anticholinergic Agent, Ophthalmic Antidote Atropine (Ophthalmic) ...... 3 Glucagon ...... 8 Anticoagulant Naloxone ...... 12 Apixaban ...... 3 Antidote, Extravasation Enoxaparin ...... 6 Nitroglycerin ...... 12 Warfarin ...... 17 Antidote, Hypoglycemia Anticoagulant, Factor Xa Inhibitor Glucagon ...... 8 Apixaban ...... 3 Antiemetic Anticoagulant, Low Molecular Weight Heparin DexAMETHasone (Systemic) ...... 5 Enoxaparin ...... 6 HydrOXYzine ...... 9 Anticoagulant, Vitamin K Antagonist Metoclopramide ...... 11 Warfarin ...... 17 Ondansetron ...... 13 Prochlorperazine ...... 14 Anticonvulsant, Barbiturate Promethazine ...... 14 PHENobarbital ...... 13 Antiflatulent Anticonvulsant, Benzodiazepine Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone ...... 2 ClonazePAM ...... 4 DiazePAM ...... 5 Antifungal Agent, Azole Derivative LORazepam ...... 10 Terconazole ...... 16 20 ANTIFUNGAL AGENT, IMIDAZOLE DERIVATIVE

Antifungal Agent, Imidazole Derivative Antilipemic Agent, Bile Acid Sequestrant Clotrimazole (Oral) ...... 4 Colestipol ...... 5 Clotrimazole (Topical) ...... 4 Ketoconazole (Systemic) ...... 10 Antilipemic Agent, Fibric Acid Ketoconazole (Topical) ...... 10 Fenofibrate and Derivatives ...... 7 Miconazole (Topical) ...... 11 Gemfibrozil ...... 8 Antifungal Agent, Oral Antilipemic Agent, HMG-CoA Reductase Inhibitor Fluconazole ...... 7 AtorvaSTATin ...... 3 Griseofulvin ...... 8 Pravastatin ...... 14 Ketoconazole (Systemic) ...... 10 Rosuvastatin ...... 15 Terbinafine (Systemic) ...... 16 Simvastatin ...... 15 Antifungal Agent, Oral Nonabsorbed Antilipemic Agent, Miscellaneous Clotrimazole (Oral) ...... 4 Niacin ...... 12 Antifungal Agent, Oral Nonabsorbed/Partially Absorbed Antilipemic Agent, Omega-3 Fatty Acids Clotrimazole (Topical) ...... 4 Omega-3 Fatty Acids ...... 12 Miconazole (Topical) ...... 11 Nystatin (Oral) ...... 12 Antimalarial Agent Atovaquone and Proguanil ...... 3 Antifungal Agent, Parenteral Hydroxychloroquine ...... 9 Fluconazole ...... 7 Primaquine ...... 14 Antifungal Agent, Topical Antimanic Agent Betamethasone and Clotrimazole ...... 3 Lithium ...... 10 Ciclopirox ...... 4 RisperiDONE ...... 14 Clotrimazole (Topical) ...... 4 Valproic Acid and Derivatives ...... 17 Ketoconazole (Topical) ...... 10 Miconazole (Topical) ...... 11 Antimigraine Agent Nystatin and Triamcinolone ...... 12 Eletriptan ...... 6 Nystatin (Topical) ...... 12 Rizatriptan ...... 14 Terbinafine (Topical) ...... 16 SUMAtriptan ...... 15 ZOLMitriptan ...... 17 Antifungal Agent, Vaginal Clotrimazole (Topical) ...... 4 Antineoplastic Agent, Antimetabolite (Antifolate) Miconazole (Topical) ...... 11 Methotrexate ...... 11 Terconazole ...... 16 Antineoplastic Agent, Aromatase Inhibitor Antigout Agent Anastrozole ...... 2 Allopurinol ...... 2 Colchicine ...... 5 Antineoplastic Agent, Estrogen Receptor Antagonist Tamoxifen ...... 15 Antihemophilic Agent Desmopressin ...... 5 Antineoplastic Agent, Hormone Megestrol ...... 11 Antihemorrhoidal Agent Hydrocortisone (Topical) ...... 8 Antiparasitic Agent, Topical Zinc Oxide ...... 17 Permethrin ...... 13 Pyrethrins and Piperonyl Butoxide ...... 14 Antihypertensive AmLODIPine ...... 2 Anti-Parkinson Agent, Anticholinergic Amlodipine and Benazepril ...... 2 Benztropine ...... 3 Atenolol ...... 3 Captopril ...... 4 Anti-Parkinson Agent, Decarboxylase Inhibitor Carvedilol ...... 4 Carbidopa and Levodopa ...... 4 Chlorthalidone ...... 4 Anti-Parkinson Agent, Dopamine Agonist CloNIDine ...... 4 Amantadine ...... 2 DilTIAZem ...... 5 Pramipexole ...... 13 Doxazosin ...... 6 ROPINIRole ...... 15 Felodipine ...... 7 Furosemide ...... 8 Anti-Parkinson Agent, Dopamine Precursor GuanFACINE ...... 8 Carbidopa and Levodopa ...... 4 HydrALAZINE ...... 8 HydroCHLOROthiazide ...... 8 Antiplatelet Agent Hydrochlorothiazide and Triamterene ...... 8 Aspirin ...... 3 Lisinopril ...... 10 Clopidogrel ...... 4 Lisinopril and Hydrochlorothiazide ...... 10 Dipyridamole ...... 5 Losartan ...... 10 Antiplatelet Agent, Thienopyridine Losartan and Hydrochlorothiazide ...... 10 Clopidogrel ...... 4 Metoprolol ...... 11 Minoxidil (Systemic) ...... 11 Antiprotozoal, Nitroimidazole NIFEdipine ...... 12 MetroNIDAZOLE (Systemic) ...... 11 Nisoldipine ...... 12 Olmesartan ...... 12 Antirheumatic, Disease Modifying Prazosin ...... 14 Methotrexate ...... 11 Propranolol ...... 14 Antiseborrheic Agent, Topical Ramipril ...... 14 Selenium Sulfide ...... 15 Spironolactone ...... 15 Telmisartan ...... 16 Antispasmodic Agent, Gastrointestinal Telmisartan and Hydrochlorothiazide ...... 16 Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ...... 9 Terazosin ...... 16 Valsartan ...... 17 Antispasmodic Agent, Urinary Valsartan and Hydrochlorothiazide ...... 17 Oxybutynin ...... 13 Verapamil ...... 17 Antithyroid Agent Anti-inflammatory Agent Propylthiouracil ...... 14 DexAMETHasone (Systemic) ...... 5 Antitubercular Agent Antilipemic Agent, 2-Azetidinone Isoniazid ...... 9 Ezetimibe ...... 7 RifAMPin ...... 14 21 DIRECT ORAL ANTICOAGULANT (DOAC)

Antitussive Calcium Salt Benzonatate ...... 3 Calcium and Vitamin D ...... 4 Guaifenesin and Codeine ...... 8 Guaifenesin and Dextromethorphan ...... 8 Carbonic Anhydrase Inhibitor Hydrocodone and Chlorpheniramine ...... 8 AcetaZOLAMIDE ...... 2 Antiviral Agent Carbonic Anhydrase Inhibitor (Ophthalmic) Acyclovir (Systemic) ...... 2 Dorzolamide and Timolol ...... 6 Amantadine ...... 2 Cardiac Glycoside Oseltamivir ...... 13 Digoxin ...... 5 ValACYclovir ...... 17 Cardiovascular Agent, Miscellaneous Antiviral Agent, Adamantane Ranolazine ...... 14 Amantadine ...... 2 Cathartic Antiviral Agent, Oral Sodium Phosphates ...... 15 ValACYclovir ...... 17 Central Nervous System Stimulant Antiviral Agent, Topical Dexmethylphenidate ...... 5 Acyclovir (Topical) ...... 2 Dextroamphetamine and Amphetamine ...... 5 Appetite Stimulant Methylphenidate ...... 11 Megestrol ...... 11 Modafinil ...... 11 Barbiturate Chloride Channel Activator Butalbital, Acetaminophen, and Caffeine ...... 3 Lubiprostone ...... 10 PHENobarbital ...... 13 Primidone ...... 14 Contraceptive Ethinyl Estradiol and Desogestrel ...... 6 Benzodiazepine Ethinyl Estradiol and Drospirenone ...... 6 ALPRAZolam ...... 2 Ethinyl Estradiol and Ethynodiol Diacetate ...... 6 ClonazePAM ...... 4 Ethinyl Estradiol and Etonogestrel ...... 6 DiazePAM ...... 5 Ethinyl Estradiol and Levonorgestrel ...... 6 LORazepam ...... 10 Ethinyl Estradiol and Norelgestromin ...... 7 Temazepam ...... 16 Ethinyl Estradiol and Norethindrone ...... 7 Ethinyl Estradiol and Norgestimate ...... 7 Beta2-Adrenergic Agonist Ipratropium and Albuterol ...... 9 Ethinyl Estradiol and Norgestrel ...... 7 Levonorgestrel (Systemic) ...... 10 Beta2-Adrenergic Agonist, Long-Acting MedroxyPROGESTERone ...... 11 Fluticasone and Salmeterol ...... 7 Norethindrone ...... 12 Salmeterol ...... 15 Corticosteroid, Inhalant (Oral) Beta2 Agonist Budesonide (Oral Inhalation) ...... 3 Albuterol ...... 2 Fluticasone and Salmeterol ...... 7 Fluticasone and Salmeterol ...... 7 Fluticasone (Oral Inhalation) ...... 8 Salmeterol ...... 15 Mometasone (Oral Inhalation) ...... 11

Beta3 Agonist Corticosteroid, Nasal Mirabegron ...... 11 Fluticasone (Nasal) ...... 8 Beta-Adrenergic Blocker, Nonselective Mometasone (Nasal) ...... 11 Dorzolamide and Timolol ...... 6 Corticosteroid, Ophthalmic Propranolol ...... 14 Difluprednate ...... 5 Sotalol ...... 15 Fluorometholone ...... 7 Beta-Blocker, Beta-1 Selective PrednisoLONE (Ophthalmic) ...... 14 Atenolol ...... 3 Corticosteroid, Otic Metoprolol ...... 11 Ciprofloxacin and Dexamethasone ...... 4 Beta-Blocker, Nonselective Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 12 Timolol (Ophthalmic) ...... 16 Corticosteroid, Rectal Beta-Blocker With Alpha-Blocking Activity Hydrocortisone (Topical) ...... 8 Carvedilol ...... 4 Corticosteroid, Systemic Bisphosphonate Derivative DexAMETHasone (Systemic) ...... 5 Alendronate ...... 2 MethylPREDNISolone ...... 11 Ibandronate ...... 9 PrednisoLONE (Systemic) ...... 14 PredniSONE ...... 14 Calcineurin Inhibitor CycloSPORINE (Ophthalmic) ...... 5 Corticosteroid, Topical Pimecrolimus ...... 13 Betamethasone and Clotrimazole ...... 3 Tacrolimus (Topical) ...... 15 Clobetasol ...... 4 Desonide ...... 5 Calcium Channel Blocker Fluocinolone (Topical) ...... 7 AmLODIPine ...... 2 Fluocinonide ...... 7 Amlodipine and Benazepril ...... 2 Hydrocortisone (Topical) ...... 8 DilTIAZem ...... 5 Nystatin and Triamcinolone ...... 12 Felodipine ...... 7 NIFEdipine ...... 12 Triamcinolone (Topical) ...... 16 Nisoldipine ...... 12 Decongestant Verapamil ...... 17 Fexofenadine and Pseudoephedrine ...... 7 Calcium Channel Blocker, Dihydropyridine Oxymetazoline (Nasal) ...... 13 AmLODIPine ...... 2 Pseudoephedrine ...... 14 Amlodipine and Benazepril ...... 2 Diagnostic Agent Felodipine ...... 7 Glucagon ...... 8 NIFEdipine ...... 12 Nisoldipine ...... 12 Dietary Supplement Lactobacillus ...... 10 Calcium Channel Blocker, Nondihydropyridine DilTIAZem ...... 5 Direct Oral Anticoagulant (DOAC) Verapamil ...... 17 Apixaban ...... 3 22 DIURETIC, CARBONIC ANHYDRASE INHIBITOR

Diuretic, Carbonic Anhydrase Inhibitor Hydrocodone and Chlorpheniramine ...... 8 AcetaZOLAMIDE ...... 2 HydrOXYzine ...... 9 Loratadine ...... 10 Diuretic, Loop Naphazoline and Pheniramine ...... 12 Furosemide ...... 8 Olopatadine (Ophthalmic) ...... 12 Diuretic, Potassium-Sparing Promethazine ...... 14 Hydrochlorothiazide and Triamterene ...... 8 Histamine H Antagonist, First Generation Spironolactone ...... 15 1 Cyproheptadine ...... 5 Diuretic, Thiazide DiphenhydrAMINE (Systemic) ...... 5 HydroCHLOROthiazide ...... 8 Hydrocodone and Chlorpheniramine ...... 8 Hydrochlorothiazide and Triamterene ...... 8 HydrOXYzine ...... 9 Lisinopril and Hydrochlorothiazide ...... 10 Naphazoline and Pheniramine ...... 12 Losartan and Hydrochlorothiazide ...... 10 Promethazine ...... 14 Olmesartan and Hydrochlorothiazide ...... 12 Telmisartan and Hydrochlorothiazide ...... 16 Histamine H1 Antagonist, Second Generation Valsartan and Hydrochlorothiazide ...... 17 Azelastine (Nasal) ...... 3 Cetirizine (Systemic) ...... 4 Diuretic, Thiazide-Related Fexofenadine ...... 7 Chlorthalidone ...... 4 Fexofenadine and Pseudoephedrine ...... 7 MetOLazone ...... 11 Loratadine ...... 10 Dopamine Antagonist Olopatadine (Ophthalmic) ...... 12 Metoclopramide ...... 11 Histamine H2 Antagonist Electrolyte Supplement, Oral RaNITIdine (Withdrawn From US Market) ...... 14 Calcium and Vitamin D ...... 4 Histone Deacetylase Inhibitor Potassium Chloride ...... 13 Valproic Acid and Derivatives ...... 17 Electrolyte Supplement, Parenteral Hormone, Posterior Pituitary Potassium Chloride ...... 13 Sodium Chloride ...... 15 Desmopressin ...... 5 Sodium Phosphates ...... 15 Hypnotic, Miscellaneous Estrogen and Progestin Combination Eszopiclone ...... 6 Estrogens (Conjugated/Equine) and Medroxyprogesterone ...... 6 Zolpidem ...... 17 Ethinyl Estradiol and Desogestrel ...... 6 Imidazoline Derivative Ethinyl Estradiol and Drospirenone ...... 6 Naphazoline and Pheniramine ...... 12 Ethinyl Estradiol and Ethynodiol Diacetate ...... 6 Oxymetazoline (Nasal) ...... 13 Ethinyl Estradiol and Etonogestrel ...... 6 Ethinyl Estradiol and Levonorgestrel ...... 6 Immunosuppressant Agent Ethinyl Estradiol and Norelgestromin ...... 7 CycloSPORINE (Ophthalmic) ...... 5 Ethinyl Estradiol and Norethindrone ...... 7 Methotrexate ...... 11 Ethinyl Estradiol and Norgestimate ...... 7 Pimecrolimus ...... 13 Ethinyl Estradiol and Norgestrel ...... 7 Tacrolimus (Topical) ...... 15 Estrogen Derivative Inhalation, Miscellaneous Estradiol (Systemic) ...... 6 Inhalation Devices ...... 9 Estradiol (Topical) ...... 6 Estrogens (Conjugated/Equine, Systemic) ...... 6 Insulin, Combination Estrogens (Conjugated/Equine, Topical) ...... 6 Insulin Aspart Protamine and Insulin Aspart ...... 9 Insulin NPH and Insulin Regular ...... 9 Ethanolamine Derivative DiphenhydrAMINE (Systemic) ...... 5 Insulin, Intermediate-Acting Insulin NPH ...... 9 Expectorant GuaiFENesin ...... 8 Insulin, Long-Acting Guaifenesin and Codeine ...... 8 Insulin Glargine ...... 9 Guaifenesin and Dextromethorphan ...... 8 Guaifenesin and Pseudoephedrine ...... 8 Insulin, Rapid-Acting Insulin Aspart ...... 9 First Generation (Typical) Antipsychotic Prochlorperazine ...... 14 Insulin, Short-Acting Insulin Regular ...... 9 GABA Analog Gabapentin ...... 8 Interferon Interferon Beta-1b ...... 9 Gastrointestinal Agent, Miscellaneous LinaCLOtide ...... 10 Iron Preparations Lubiprostone ...... 10 Ferrous Sulfate ...... 7 Sucralfate ...... 15 Irrigant Gastrointestinal Agent, Prokinetic Sodium Chloride ...... 15 Metoclopramide ...... 11 Keratolytic Agent Genitourinary Irrigant Salicylic Acid ...... 15 Sodium Chloride ...... 15 Tazarotene ...... 15 Guanylate Cyclase-C (GC-C) Agonist Laxative, Bowel Evacuant LinaCLOtide ...... 10 Sodium Phosphates ...... 15 Hemostatic Agent Laxative, Osmotic Aluminum Chloride Hexahydrate ...... 2 Glycerin ...... 8 Desmopressin ...... 5 Lactulose ...... 10 Polyethylene Glycol 3350 ...... 13 Histamine H1 Antagonist Azelastine (Nasal) ...... 3 Polyethylene Glycol-Electrolyte Solution ...... 13 Cetirizine (Systemic) ...... 4 Laxative, Stimulant Cyproheptadine ...... 5 Bisacodyl ...... 3 DiphenhydrAMINE (Systemic) ...... 5 Fexofenadine ...... 7 Leukotriene-Receptor Antagonist Fexofenadine and Pseudoephedrine ...... 7 Montelukast ...... 11 23 SMOKING CESSATION AID

Local Anesthetic Phenothiazine Derivative Benzocaine ...... 3 Prochlorperazine ...... 14 Lidocaine (Topical) ...... 10 Promethazine ...... 14 Lubricant, Ocular Phosphodiesterase-5 Enzyme Inhibitor Sodium Chloride ...... 15 Sildenafil ...... 15 Mineralocorticoid (Aldosterone) Receptor Antagonists Phosphodiesterase Enzyme Inhibitor, Nonselective Spironolactone ...... 15 Theophylline ...... 16 Miscellaneous Product Piperazine Derivative Diabetic Supplies ...... 5 Cetirizine (Systemic) ...... 4 Sinus Rinse ...... 15 HydrOXYzine ...... 9 Neuraminidase Inhibitor Piperidine Derivative Oseltamivir ...... 13 Cyproheptadine ...... 5 Fexofenadine ...... 7 N-Methyl-D-Aspartate (NMDA) Receptor Antagonist Fexofenadine and Pseudoephedrine ...... 7 Memantine ...... 11 Loratadine ...... 10 Nonsteroidal Anti-inflammatory Drug (NSAID) Olopatadine (Ophthalmic) ...... 12 Diclofenac (Ophthalmic) ...... 5 Probiotic Diclofenac (Systemic) ...... 5 Lactobacillus ...... 10 Diclofenac (Topical) ...... 5 Progestin Nonsteroidal Anti-inflammatory Drug (NSAID), COX-2 Selective Levonorgestrel (Systemic) ...... 10 Celecoxib ...... 4 MedroxyPROGESTERone ...... 11 Nonsteroidal Anti-inflammatory Drug (NSAID), Ophthalmic Megestrol ...... 11 Diclofenac (Ophthalmic) ...... 5 Norethindrone ...... 12 Progesterone ...... 14 Nonsteroidal Anti-inflammatory Drug (NSAID), Oral Aspirin ...... 3 Prostaglandin Diclofenac (Systemic) ...... 5 MiSOPROStol ...... 11 Ibuprofen ...... 9 Prostaglandin, Ophthalmic Indomethacin ...... 9 Latanoprost ...... 10 Meloxicam ...... 11 Naproxen ...... 12 Proton Pump Inhibitor Piroxicam (Systemic) ...... 13 Esomeprazole ...... 6 Omeprazole ...... 13 Nonsteroidal Anti-inflammatory Drug (NSAID), Parenteral Pantoprazole ...... 13 Ibuprofen ...... 9 RABEprazole ...... 14 Indomethacin ...... 9 Meloxicam ...... 11 Retinoic Acid Derivative Tazarotene ...... 15 Nonsteroidal Anti-inflammatory Drug (NSAID), Topical Tretinoin (Topical) ...... 16 Diclofenac (Topical) ...... 5 Rifamycin Norepinephrine Reuptake Inhibitor, Selective RifAMPin ...... 14 AtoMOXetine ...... 3 Salicylate Nutritional Supplement Aspirin ...... 3 Fluoride ...... 7 Scabicidal Agent Ophthalmic Agent, Antiglaucoma Permethrin ...... 13 AcetaZOLAMIDE ...... 2 Brimonidine (Ophthalmic) ...... 3 Second Generation (Atypical) Antipsychotic Dorzolamide and Timolol ...... 6 ARIPiprazole ...... 3 Latanoprost ...... 10 QUEtiapine ...... 14 Pilocarpine (Ophthalmic) ...... 13 RisperiDONE ...... 14 Timolol (Ophthalmic) ...... 16 Selective 5-HT3 Receptor Antagonist Ophthalmic Agent, Miotic Ondansetron ...... 13 Pilocarpine (Ophthalmic) ...... 13 Selective Estrogen Receptor Modulator (SERM) Ophthalmic Agent, Miscellaneous ClomiPHENE ...... 4 Artificial Tears ...... 3 Raloxifene ...... 14 Carboxymethylcellulose ...... 4 Tamoxifen ...... 15 Ophthalmic Agent, Mydriatic Serotonin 5-HT1B, 1D Receptor Agonist Atropine (Ophthalmic) ...... 3 Eletriptan ...... 6 Tropicamide ...... 16 Rizatriptan ...... 14 SUMAtriptan ...... 15 Ophthalmic Agent, Vasoconstrictor ZOLMitriptan ...... 17 Naphazoline and Pheniramine ...... 12 Serotonin 5-HT4 Receptor Agonist Opioid Antagonist Metoclopramide ...... 11 Naloxone ...... 12 Shampoo, Pediculocide Otic Agent, Anti-infective Pyrethrins and Piperonyl Butoxide ...... 14 Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone ...... 2 Skeletal Muscle Relaxant Ovulation Stimulator Cyclobenzaprine ...... 5 ClomiPHENE ...... 4 Methocarbamol ...... 11 P2Y12 Antagonist Skin and Mucous Membrane Agent Clopidogrel ...... 4 Imiquimod ...... 9 Partial Nicotine Agonist Skin and Mucous Membrane Agent, Miscellaneous Varenicline ...... 17 Emollients ...... 6 Pediculocide Smoking Cessation Aid Permethrin ...... 13 BuPROPion ...... 3 Pyrethrins and Piperonyl Butoxide ...... 14 Varenicline ...... 17 24 SODIUM SALT

Sodium Salt Sodium Chloride ...... 15 Stool Softener Docusate ...... 5 Substituted Benzimidazole Esomeprazole ...... 6 Omeprazole ...... 13 Pantoprazole ...... 13 RABEprazole ...... 14 Thioamide Propylthiouracil ...... 14 Thyroid Product Levothyroxine ...... 10 Thyroid, Desiccated ...... 16 Topical Skin Product Aluminum Chloride Hexahydrate ...... 2 Benzoyl Peroxide ...... 3 Calcipotriene ...... 3 Capsaicin ...... 4 Clindamycin and Benzoyl Peroxide ...... 4 Emollients ...... 6 Erythromycin (Topical) ...... 6 Imiquimod ...... 9 Lactic Acid and Ammonium Hydroxide ...... 10 Pimecrolimus ...... 13 Selenium Sulfide ...... 15 Tacrolimus (Topical) ...... 15 Zinc Oxide ...... 17 Topical Skin Product, Acne Benzoyl Peroxide ...... 3 Clindamycin and Benzoyl Peroxide ...... 4 Clindamycin (Topical) ...... 4 Erythromycin (Topical) ...... 6 Salicylic Acid ...... 15 Sulfacetamide (Topical) ...... 15 Tazarotene ...... 15 Tretinoin (Topical) ...... 16 Transient Receptor Potential Vanilloid 1 (TRPV1) Agonist Capsaicin ...... 4 Uricosuric Agent Probenecid ...... 14 Vasodilator Dipyridamole ...... 5 HydrALAZINE ...... 8 Isosorbide Dinitrate ...... 9 Isosorbide Mononitrate ...... 10 Nitroglycerin ...... 12 Vasodilator, Direct-Acting Minoxidil (Systemic) ...... 11 Vasopressin Analog, Synthetic Desmopressin ...... 5 Vitamin Vitamins (Multiple/Prenatal) ...... 17 Vitamin D Analog Calcipotriene ...... 3 Calcitriol (Systemic) ...... 3 Vitamin, Fat Soluble Calcium and Vitamin D ...... 4 Vitamin, Water Soluble Cyanocobalamin ...... 5 Folic Acid ...... 8 Niacin ...... 12 Pyridoxine ...... 14 Thiamine ...... 16 Xanthine Oxidase Inhibitor Allopurinol ...... 2 25